Pletz Mathias W, Weis Sebastian, Forstner Christina, Wagenlehner Florian
Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
Center for Sepsis Control and Care, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
Med Klin Intensivmed Notfmed. 2018 Mar;113(2):143-156. doi: 10.1007/s00063-018-0406-1.
Urosepsis is defined as a severe disease due to organ failure caused by a urinary tract infection. An empirical antibiotic therapy should be instigated within the first hour after diagnosis. Urine cultures and blood cultures should be performed before antibiotic treatment. Further diagnostics should be carried out at an early stage to enable an interventional focus control in the case of urinary tract obstruction or abscess formation, if necessary. Gram-negative pathogens are most frequently isolated. Extended spectrum beta-lactamase (ESBL) forming bacteria as a cause of urosepsis are increasing. Carbapenemase-forming Enterobacteriaceae, on the other hand, are still rare. The empirical treatment consists of a broad spectrum beta-lactam antibiotic. While piperacillin/tazobactam, carbapenems and the new cephalosporin/beta-lactamase inhibitor (BLI) combinations are given as monotherapy, cephalosporins should be combined with aminoglycosides (preferred) or fluoroquinolones. If a combination therapy is given, it should be de-escalated to a monotherapy after 48-72 h.
泌尿道脓毒症被定义为由尿路感染引起的器官衰竭所致的严重疾病。应在诊断后的第一小时内开始经验性抗生素治疗。在抗生素治疗前应进行尿培养和血培养。如有必要，应在早期进行进一步诊断，以便在发生尿路梗阻或脓肿形成时能够进行介入性病灶控制。革兰氏阴性病原体最常被分离出来。产超广谱β-内酰胺酶（ESBL）的细菌作为泌尿道脓毒症的病因正在增加。另一方面，产碳青霉烯酶的肠杆菌科细菌仍然很少见。经验性治疗包括使用广谱β-内酰胺抗生素。哌拉西林/他唑巴坦、碳青霉烯类和新型头孢菌素/β-内酰胺酶抑制剂（BLI）组合可作为单一疗法使用，而头孢菌素应与氨基糖苷类（首选）或氟喹诺酮类联合使用。如果采用联合治疗，应在48-72小时后降级为单一疗法。
