Antibiotic Stewardship (ABS) im Kontext schwerer Infektionen

BACKGROUND: Severe infections are a major clinical challenge due to frequent complications and high mortality rates. OBJECTIVE: The use and impact of antibiotic stewardship (ABS) strategies in the context of severe infections are explained using the examples of sepsis, gram-negative bloodstream infections and coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS: The current literature and recommendations are summarized with a focus on clinical ABS implications in severe infections, such as sepsis, gram-negative bloodstream infections and COVID-19. RESULTS: Sepsis: the updated sepsis guidelines propose a differentiated approach concerning the start of antibiotic treatment in patients with sepsis and absence of shock. In patients with an uncertain diagnosis and no signs of shock in the time period before initiating antibiotic treatment can be extended to 3 h. Within this time frame, the differential diagnostic investigations including adequate microbiological sampling should be completed in order to initiate or alternatively reject the start of antibiotic treatment based on reliable results. Gram-negative bloodstream infections: for uncomplicated gram-negative bloodstream infections, 7 days of antibiotic treatment is sufficient. According to current data a regular combination treatment for bloodstream infections due to Pseudomonas aeruginosa is not indicated. COVID-19: bacterial co-infections in COVID-19 are rare. A prophylactic antibiotic treatment is therefore not justified. Secondary bacterial infections (> 48 h after hospitalization) occur primarily in critically ill COVID-19 patients. In the case of pulmonary coinfection or secondary infection, a therapeutic approach in accordance with the current pneumonia guidelines is recommended. CONCLUSION: Despite the severity and complexity of these severe infections, the basic principles of antibiotic stewardship (ABS) apply in terms of a rational anti-infective prescription with respect to the substance, dosage and duration of treatment.