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Antimikrobielle Therapie bei Patienten nach Verbrennungstrauma

Antimicrobial treatment in burn injury patients

  • Klinische Pharmakologie
  • Published:
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Zusammenfassung

Patienten mit schweren Verbrennungstraumen sind u. a. durch infektiöse Komplikationen gefährdet. Eine Hauptgefahr stellt die Infektion mit multiresistenten bakteriellen Erregern dar; Pilz- und virale Infektionen erhöhen das Mortalitätsrisiko zusätzlich. Neben profunden Kenntnissen über die besondere Infektionsgefährdung in dieser speziellen Patientenpopulation sowie über die frühzeitige Diagnose und Einleitung einer adäquaten Therapie sind auch Kenntnisse über die Änderung pharmakokinetischer und pharmakodynamischer Parameter der einzelnen antimikrobiellen Substanzen von Bedeutung. Diese sind u. a. in der Veränderung der Flüssigkeitskompartimente, der Albuminkonzentration und der freien Fraktion der Substanzen begründet. Die vorliegende Übersicht fasst die bisherigen Erkenntnisse zusammen und gibt eine Handlungsanweisung für die praktische Durchführung der antimikrobiellen Therapie bei Verbrennungspatienten.

Abstract

Infections are a great diagnostic and therapeutic challenge in intensive care patients with burn injuries. The major problems are due to bacteria with hospital-acquired multiresistance to antibiotics but fungal and viral infections may also be life-threatening. The main key points addressing pharmacotherapy with antibiotic, antifungal and antiviral agents in this special setting are exact diagnosis, early therapy with suitable drugs, adequate duration of treatment and adequate doses based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The latter parameters are significantly altered in burn patients and show a wide interindividual and intraindividual variation in drug response as a result of the characteristic phases of burn injury. Drug concentration analysis may help to avoid inadequate dosing. In this review the main characteristics of burn injuries and the pharmacology of antibiotics, antifungal and antiviral agents in these patients are presented.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Prof. Kleinschmidt und Dr. Trupkovic erhielten in der Vergangenheit Referentenhonorare und Reisekostenerstattungen der Fa. Pfizer GmbH und weisen damit auf einen möglichen Interessenkonflikt hin. Dr. Gille und Dr. Fischer erklären, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    T. Trupkovic &  S. Kleinschmidt

  2. Klinik für Anästhesiologie, Intensiv- und Schmerztherapie, Städtisches Klinikum „St. Georg“, Leipzig, Deutschland

    J. Gille & H. Fischer

Authors
  1. T. Trupkovic
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  2. J. Gille
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  3. H. Fischer
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  4. S. Kleinschmidt
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Correspondence to S. Kleinschmidt.

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Trupkovic, T., Gille, J., Fischer, H. et al. Antimikrobielle Therapie bei Patienten nach Verbrennungstrauma. Anaesthesist 61, 249–258 (2012). https://doi.org/10.1007/s00101-012-1994-4

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  • DOI: https://doi.org/10.1007/s00101-012-1994-4

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