Multiresistente Erreger - Therapiestrategien

Abstract

Infections with multi-drug resistant bacteria are increasing worldwide. Glycopeptides, linezolid, daptomycin and 5th generation cephalosporins ("MRSA-cephalsoporins") are used against severe infections with MRSA, combination partners are rifampin and fosfomycin. Treatment options against VRE-infections are limited to linezolid, daptomycin and tigecyclin. New agents with activity against MRSA and VRE are tedizolid, dalbvancin and oritavancin. For monotherapy of severe infections due to 3MRGN carbapenems are available. Ceftolozane/tazobactam has been licensed by the European Medical Agency and shows good activity against a relevant proportion of ESBL-pathogens. Oral agents such as nitrofurantoin or fosfomycin are used for treatment of uncomplicated cystitis. Colistin shows best in vitro susceptibility against carbapenem-resistant Enterobacteriaceae, followed by fosfomycin and tigecycline. For serious infections with 4MRGN a colistin-based combination treatment with two to three agents is recommended. In such cases a carbapenem as combination partner may be useful.