Sepsis and MODS
Lernkarten zu PACT
Lernkarten zu PACT
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Lernkarten
Wie wirkt recombinant human activated protein C (rhAPC)? 3
Indikation?
Welche Patienten?
reduction of thrombin formation, an anti-inflammatory effect and reduction of rolling of monocytes and neutrophils
Indikation:
within 24 hours of diagnosis of severe sepsis and sepsis induced organ dysfunction
in septic patients with an APACHE 2 score ≥25 but not in those with a score <20
Welche Nebenwirkung?
Blutung!
Wann sollte Antibiotika-Therapie reevaluiert werden?
Wann evaluiert zu stoppen?
Oder?
- On day two to three to decide if antibiotic treatment should be stopped (because there is no bacterial infection) or changed.
- On day seven to ten to decide if antibiotic treatment should be continued.
- At any time if failure is suspected.
Was tun bei Therapieversagen? 3
- Examine the patient. Pay attention to intravascular catheters and surgical wound sites.
- Discuss the apparent failure with the microbiologist. Check the results of susceptibility tests when available.
- Obtain new specimens for microbiological analysis according to clinical assessment rather than laboratory requests.
6 Fragen, wenn Therapie versagt?
- Was the initial anti-infective treatment appropriate?
- Is there a possible focus of infection that has not been eradicated (catheter to remove, abscess to drain,...)?
- Has the initial pathogen developed resistance to the antibiotics?
- Is the pathogen non-bacterial: e.g. a fungus such as Aspergillus spp. or Candida spp.?
- Has the patient developed nosocomial infection?
- Is the fever due to non-infectious aetiologies?
Welche Gründe gibt's für AB-Wechsel? 5
- The pathogen is not susceptible to the chosen regimen.
- The infection is polymicrobial and not all of the pathogens are adequately covered.
- Combination therapy was used but since the pathogen is fully susceptible, monotherapy may be adequate.
- Monotherapy was used but the bacterium is not fully susceptible (i.e. P. aeruginosa) and thus combination therapy may be preferable.
- Antibiotics with a narrower antimicrobial spectrum are active, enabling cessation of broad-spectrum antibiotics: a de-escalation strategy.
Wovon hängt AB-Dauer ab? 7
- What is the immune status of the patient?
- What is the involved pathogen?
- What is the site of infection?
- Is the clinical response to appropriate antibiotic treatment favourable?
- Is the patient still exposed to the risk: i.e. if the patient was treated for VAP, is he still on mechanical ventilation?
- Was the focus of infection removed?
- Does the patient have a prosthetic device (endovascular, osteo-articular)?
Gründe für kurze AB-Dauer? 4
- The patient is immunocompetent
- The pathogen is fully susceptible to antibiotics
- There is no internal device
- The antibiotic is thought to readily diffuse into the site of infection (i.e. absence of deep-seated infection such as endocarditis)
Welche Erkrankungen erfordern Therapiedauer >21 d?
Prostatitis
Linksherz-Endokarditis mit künstl. Device
Leber- und Hirnabszess
Osteoartikuläre Infekte, besonders mit Protesen
Welche Erreger entwickeln schnell Resistenzen?3
Pseudomonas
Enterobacteriacea
S.aureus
Goldene Regeln der antimikrobiellen Therapie? 7
1. Empirical antibiotic therapy should be started without delay in septic patients.
2. Only antibiotics not prescribed in the previous two weeks should be considered.
3. MRSA is not expected in absence of previous antibiotic use.
4. The antibiotic regimen should be targeted based on rapidly obtained direct tests.
5. The antibiotic regimen should be modified based on microbiologic findings.
6. Use a combination of antibiotics when appropriate.
7. Prolonging antibiotic treatment does not prevent recurrence.
