Mischnik Alexander, Werner Guido, Bender Jennifer, Mutters Nico Tom
Dtsch Med Wochenschr. 2019 Apr;144(8):553-560. doi: 10.1055/a-0655-6454. Epub 2019 Apr 15.
Enterococci with special resistance patterns (mainly vancomycin-resistant enterococci) play an important role in everyday clinical practice. Rising resistance rates to linezolid, daptomycin or tigecycline are also increasingly reported. Therapeutically, linezolid and daptomycin are the most important substances mainly in infections due to vancomycin-resistant enterococci. Several systematic meta-analyses of bloodstream infections showed discrepant results in the comparison of mortality of linezolid and daptomycin-treated bacteraemias. The containment of enterococci with special resistance patterns is currently receiving great attention. The key hygienic issue in all recommendations for dealing with multidrug-resistant enterococci can be summarized very simply: current scientific evidence is often inconsistent and studies that have clearly tested a single intervention for efficacy are lacking. The present work gives an insight into the current epidemiology and therapeutic strategies. Furthermore, the recently published German KRINKO recommendations are presented.
具有特殊耐药模式的肠球菌(主要是耐万古霉素肠球菌)在日常临床实践中起着重要作用。对利奈唑胺、达托霉素或替加环素耐药率上升的报道也越来越多。在治疗方面,利奈唑胺和达托霉素是治疗耐万古霉素肠球菌感染最重要的药物。多项关于血流感染的系统荟萃分析在比较利奈唑胺和达托霉素治疗菌血症的死亡率时得出了不一致的结果。目前,具有特殊耐药模式的肠球菌的控制受到了极大关注。在所有应对多重耐药肠球菌的建议中,关键的卫生问题可以非常简单地概括为:当前的科学证据往往不一致,而且缺乏明确测试单一干预措施疗效的研究。本研究深入探讨了当前的流行病学和治疗策略。此外,还介绍了最近发布的德国KRINKO建议。