Wege zum fachgerechten und verantwortungsvollen Umgang mit Antibiotika

Deutschland nimmt im europäischen Vergleich bei der Antibiotikaverschreibung eine Position im Niedrigverschreibungsbereich ein, es existieren aber einige Länder, insbesondere Schweden und die Niederlande, welche deutlich weniger Antibiotika verschreiben. In Deutschland werden im ambulanten Bereich v. a. zu viele Antibiotika bei leichtgradigen und nichtbakteriellen Infektionen verschrieben und häufig die falschen Breitspektrumantibiotika statt Schmalspektrumantibiotika angewendet, im stationären Bereich wird v. a. die perioperative Prophylaxe zu lang gegeben. Im Artikel werden verschiedene Ansätze für eine rationale Antibiotikagabe vorgestellt und Empfehlungen zum Umgang mit Antibiotika, zur Anwendung von Diagnostika und Scores sowie zu Informationen für Ärzte und Patienten gegeben. Hierfür wurde eine unsystematische Literatursicht durchgeführt. Zur Optimierung der Verschreibungsqualität von Antibiotika sollte der Arzt bei jedem Patienten mit einer Infektionskrankheit eine Checkliste abarbeiten. Die entscheidenden Eingangsfragen sind, ob eine bakterielle Infektion vorliegt und ein Antibiotikum gegeben werden muss. Der Diagnostik kommt eine wichtige Rolle zu. Mit richtig angewendeten Schnelltests (Point-of-Care-Testing, POCT) kann die Antibiotikatherapie verkürzt oder teilweise ganz auf sie verzichtet werden. Erreger- und Resistenztestung tragen zur Qualitätssicherung bei. S3-Leitlinien sind das Fundament einer modernen evidenzbasierten Medizin. Die Kommunikation im Team und mit den Patienten ist ein weiterer wichtiger Faktor. Alle Maßnahmen, wie Durchführung eines Schnelltests, verzögerte Rezeptierung von Antibiotika, Verschreibung eines Antibiotikums, müssen kommunikativ richtig begleitet werden.Peer Reviewe

Validation of VITEK 2 Version 4.01 Software for Detection, Identification, and Classification of Glycopeptide-Resistant Enterococci

We evaluated the ability of the new VITEK 2 version 4.01 software to identify and detect glycopeptide-resistant enterococci compared to that of the reference broth microdilution method and to classify them into the vanA, vanB, vanC1, and vanC2 genotypes. Moreover, the accuracy of antimicrobial susceptibility testing with agents with improved potencies against glycopeptide-resistant enterococci was determined. A total of 121 enterococci were investigated. The new VITEK 2 software was able to identify 114 (94.2%) enterococcal strains correctly to the species level and to classify 119 (98.3%) enterococci correctly to the glycopeptide resistance genotype level. One Enterococcus casseliflavus strain and six Enterococcus faecium vanA strains with low-level resistance to vancomycin were identified with low discrimination, requiring additional tests. One of the vanA strains was misclassified as the vanB type, and one glycopeptide-susceptible E. facium wild type was misclassified as the vanA type. The overall essential agreements for antimicrobial susceptibility testing results were 94.2% for vancomycin, 95.9% for teicoplanin, 100% for quinupristin-dalfopristin and moxifloxacin, and 97.5% for linezolid. The rates of minor errors were 9% for teicoplanin and 5% for the other antibiotic agents. The identification and susceptibility data were produced within 4 h to 6 h 30 min and 8 h 15 min to 12 h 15 min. In conclusion, use of VITEK 2 version 4.01 software appears to be a reliable method for the identification and detection of glycopeptide-resistant enterococci as well as an improvement over the use of the former VITEK 2 database. However, a significant reduction in the detection time would be desirable

Excretion of Ascaris lumbricoides following reduced‐intensity allogeneic hematopoietic stem cell transplantation and consecutive treatment with mebendazole

Here, we present the unique case of a 51‐year‐old German patient with multiple myeloma excreting Ascaris lumbricoides in his stool five weeks after allogeneic hematopoietic stem cell transplantation. Stool analysis remained negative for the presence of eggs, and there was no eosinophilia in the peripheral blood at any time around stem cell transplantation. The patient was commenced on a three‐day treatment with mebendazole, which was well tolerated. No serious interactions with the concomitant post‐transplant medication or negative effects on the hematopoiesis were observed, and the myeloma still is in complete remission. To our knowledge, this is the first report on excretion of A lumbricoides in the context of allogeneic stem cell transplantation. The case is remarkable with view to the fact that the parasite has supposedly survived all courses of myeloma treatment including autologous and allogeneic conditioning. Parasitosis with A lumbricoides has a worldwide prevalence of about a billion and is extremely rare in northern Europe. Possibly the patient got infected during a trip to Egypt years before multiple myeloma was diagnosed

Excretion of Ascaris lumbricoides

Here, we present the unique case of a 51‐year‐old German patient with multiple myeloma excreting Ascaris lumbricoides in his stool five weeks after allogeneic hematopoietic stem cell transplantation. Stool analysis remained negative for the presence of eggs, and there was no eosinophilia in the peripheral blood at any time around stem cell transplantation. The patient was commenced on a three‐day treatment with mebendazole, which was well tolerated. No serious interactions with the concomitant post‐transplant medication or negative effects on the hematopoiesis were observed, and the myeloma still is in complete remission. To our knowledge, this is the first report on excretion of A lumbricoides in the context of allogeneic stem cell transplantation. The case is remarkable with view to the fact that the parasite has supposedly survived all courses of myeloma treatment including autologous and allogeneic conditioning. Parasitosis with A lumbricoides has a worldwide prevalence of about a billion and is extremely rare in northern Europe. Possibly the patient got infected during a trip to Egypt years before multiple myeloma was diagnosed

Evaluation of New Colorimetric Vitek 2 Yeast Identification Card by Use of Different Source Media ▿

The new colorimetric Vitek 2 YST card was evaluated for identification of yeasts (136 strains) with respect to the influence of different source media. The Vitek 2 YST card achieved satisfactory results for all yeast species tested, with the exception of Candida guilliermondii, Candida norvegensis, Candida parapsilosis, Candida rugosa, and Candida tropicalis. After simple additional tests, 93.7% of all the strains tested were correctly identified. A significant influence of the isolation medium on the identification rate could not be observed

Human Tuberculous Meningitis Caused by <i>Mycobacterium caprae</i>

Introduction: Tuberculous meningitis (TM) causes substantial morbidity and mortality in humans. Human TM has been known to be induced by bacteria from the Mycobacterium tuberculosis complex(MTBC), such as M. tuberculosis and M. bovis. Case Presentation: We describe a case of meningitis treated with fosfomycin, which showed partial effectiveness in an 80-year-old patient. After a lethal myocardial infarction, M. caprae (MC) was identified in cerebrospinal fluid culture. This isolated acid-fast organism was first identified as MTBC by MTBC-specific PCR (16S rDNA-PCR). Furthermore, species-specific identification of the isolate was done by gyrB PCR-restriction fragment length polymorphism analysis of a part of gyrB DNA. Colony morphology of the isolated MC strain showed dysgonic growth on Lowenstein-Jensen medium. The strain was susceptible to pyrazinamide (PZA). Conclusion: This isolated strain was convincingly identified as MC according to the phenotypic and genotypic characteristics and PZA sensitivity. This is the first report of MC causing TM