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Prävention und Therapie der Sepsis bei operativen Risikopatienten

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Sepsis

Zusammenfassung

Sepsis ist wahrscheinlich die größte Einzelkomplikation in den USA, was Mortalität, Morbidität und Kosten anbelangt. Annähernd 20 Mio. Menschen werden jährlich chirurgisch behandelt. Von diesen entwickeln etwa 7% (1,4 Mio.) eine Infektion [70]. Die Extrakosten für die Behandlung dieser Infektionen betragen wenigstens 1100–1500 $ pro Patient und annähernd 15–20 Mrd. $ jährlich. Dazu kommen wenigstens 5–10% von den 3 Mio. Verletzungen, die in den USA zu Arbeitsunfähigkeit und gleichfalls zu Infektionen führen. Auf die jährlich 100 000 Verletzungstoten kommen wenigstens 10% Sepsisfälle. Bei Verletzungsopfern, die 48 h überleben, verursacht Sepsis den größten Teil der Todesfälle.

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Literatur

  1. Alexander JW, Fischer JE, Boyajian M et al. (1983) The influence of hair-removal methods on wound infections. Arch Surg 118: 347–352

    Article  PubMed  CAS  Google Scholar 

  2. Alexander JW, Fischer MW (1974) Immunization against Pseudomonas infection after thermal injury. J Infect Dis 130: 152–158

    Article  Google Scholar 

  3. Antonacci AC, Chio J, Calvano SE et al. (1984) Development of monoclonal antibodies against virulent Gram-negative bacteria: Efficacy in a septic mouse mode. Surg Forum 35: 116–118

    Google Scholar 

  4. Baker CC, Oppenheimer I, Stephens B et al. (1980) Epidemiology of trauma deaths. Am J Surg 140: 144–148

    Article  PubMed  CAS  Google Scholar 

  5. Beale J (1985) Discussion of patterns of infection and mortality in thoracic trauma. Ann Surg 201: 756

    Google Scholar 

  6. Bender EM, Hansbrough JF, Anderson J et al. (1984) Prevention of post-burn alterations in helper and suppressor T-lymphocytes by cimetidine. Surg Forum 35: 156–158

    Google Scholar 

  7. Brackman R, Schouten HJ, Blaauw-van Dishoeck M et al. (1983) Magadose steroids in severe head injury. J Neurosurg 58: 326–330

    Article  Google Scholar 

  8. Calvand SF, Chiao J, Antonacci AC et al. (1984) Changes in rat lymphoid organ lymphocyte subpopulations following thermal injury. Surg Forum 35: 153–155

    Google Scholar 

  9. Chang AE, Rosenberg SA (1984) Systemic administration of recombinant Interleukin-2 in mice. Surg Forum 35: 137–139

    Google Scholar 

  10. Christou NV, McLean APH, Meakins JL (1980) Host defense in blunt trauma. Interrelationships of kinetics of anergy and depressed neutrophil function, nutritional status and sepsis. J Trauma 20: 833–841

    Article  PubMed  CAS  Google Scholar 

  11. Chu DZJ, Nishioka K, Romsdahl MM (1984) Effect of tuftsin on postsplenectomy sepsis. Surg Forum 35: 162–164

    Google Scholar 

  12. Clowes GHA, George BC, Villee CA et al. (1983) Muscle proteolyses induced by a circulating peptide in patients with sepsis or trauma. N Engl J Med 308: 545–552

    Article  PubMed  Google Scholar 

  13. Cooper PR, Moody S, Clark WK et al. (1979) Dexamethasone and severe head injury. J Neurosurg 51: 307–316

    Article  PubMed  CAS  Google Scholar 

  14. Cruse PJE, Foord R (1980) The epidemiology of wound infection: A ten year prospective study of 62,939 wounds, Surg Clin North Am 60: 27–40

    PubMed  CAS  Google Scholar 

  15. Dale DC, Petersdorf RG (1973) Corticosteroids and infectious diseases. Med Clin North Am 57: 1277–1287

    PubMed  CAS  Google Scholar 

  16. Davidson AIG, Clark G, Smith G (1971) Postoperative wound infection, a computer analysis. Br J Surg 58: 333–337

    Article  PubMed  CAS  Google Scholar 

  17. Dellinger EP, Oreskovich MR, Wertz JM et al. (1984) Risk of infection following laparotomy for penetrating abdominal injury. Arch Surg 119: 20–27

    Article  PubMed  CAS  Google Scholar 

  18. De Maria EJ, Reichman W, Kenney PR et al. (1985) Septic Complications of corticosteroid administration after central nervous system trauma. Ann Surg 202: 248–252

    Article  Google Scholar 

  19. Dunhamüi CM, Lamonica C (1984) Prolonged tracheal intubation in the trauma patient. J Trauma 24: 120–124

    Article  Google Scholar 

  20. Dunn DL, Mach PA, Cerra FB (1983) Monoclonal antibodies protect against lethal effects of Gram-negative bacterial sepsis. Surg Forum 34: 142–144

    Google Scholar 

  21. El-Naggar M, Sadogopan S, Levine H et al. (1976) Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure: A prospective study. Anesth Analg 55: 195–201

    Article  PubMed  CAS  Google Scholar 

  22. Fauci AS, Dale DC, Balow JE (1976) Glucocorticosteroid therapy: mechanism of action and clinical considerations. Ann Int Med 84: 304

    Article  PubMed  CAS  Google Scholar 

  23. Fincke BF, Friedland G (1976) Prevention and management of infection in the cathetarized patient. Urol Clin North Am 3: 313–321

    PubMed  CAS  Google Scholar 

  24. Freischlag J, Backstrom B, Busuttil RW (1983) Cytotoxic and bacteriacidal effects of povidone-iodine. Surg Forum 34: 125–127

    CAS  Google Scholar 

  25. Fried RC, Stein TP, Mullen JL et al. (1984) Improved nitrogen retention and decreased endogenous lipid mobilization with mixed substrates in septic rats. Surg Forum 35: 124–127

    CAS  Google Scholar 

  26. Fullen WD, Hunt J, Altmeister WS (1972) Prophylactic antibiotics in penetrating wounds of the abdomen. J Trauma 12: 282–289

    Article  PubMed  CAS  Google Scholar 

  27. Galle PC, Homesley HD, Rhyne AL (1978) Reassessment of the surgical scrub. Surg Gynecol Obstet 147: 215–218

    PubMed  CAS  Google Scholar 

  28. Garibaldi RA, Burke JP, Dickman ML et al. (1974) Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 291: 215–219

    Article  PubMed  CAS  Google Scholar 

  29. Gray DT, Pine PW, Harnar TJ et al. (1982) Early surgical excision versus conservative therapy in patients with 20 to 40 percent burns. A comparative study. Am J Surg 144: 76–80

    Article  PubMed  CAS  Google Scholar 

  30. Grossman JE, Demling RH, Duy ND et al. (1980) Response of fibronectin in major body burns. J Trauma 20: 967–970

    Article  PubMed  CAS  Google Scholar 

  31. Grover FL, Richardson JD, Fewel JG et al. (1977) Prophylactic antibiotics in the treatment of penentration chest wounds: A prospective double-blind study. J Thorac Cardiovasc Surg 74: 585–589

    Google Scholar 

  32. Haley RW, Chaberg DR, Crossley KB (1981) Extra charges and prolongation of stay attributable to nosocomial infections: A prospective interhospital comparison. Am J Med 70: 51–58

    Article  PubMed  CAS  Google Scholar 

  33. Haley RW, Culver DH, White JW et al. (1985) The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 121: 182–205

    PubMed  CAS  Google Scholar 

  34. Haley RW, Culver DH, Morgan WM et al. (1985) Identifying patients at high risk of surgical wound infection: A simple mulitvariate index of patient susceptibility and wound contamination. Am J Edpidemiol 121: 206–215

    CAS  Google Scholar 

  35. Haley RW, Culver DH, Morgan WM et al. (1986) Prevention of surgical sound infections. Am J Infect Control 14: 71–80

    Article  Google Scholar 

  36. Hansbrough JF, Peterson V, Kortz E et al. (1983) Post burn immunosuppression in an animal model. Monocyte dysfunction induced by burned tissue. Surgery 93: 415–423

    PubMed  CAS  Google Scholar 

  37. Heggers JP (1979) The use of antimicrobial agents. Clin Plast Surg 6: 545–551

    PubMed  CAS  Google Scholar 

  38. Heggers JP, Robson MC, Kurran JO et al. (1984) Skin testing, a valuable predictor in thermal injury? Arch Surg 119: 49–52

    Article  PubMed  CAS  Google Scholar 

  39. Hiebert JM, McGough M, Rudehearer G et al. (1979) The influence of catabolism or immunocompetence in burned patients. Surgery 86: 242–247

    PubMed  CAS  Google Scholar 

  40. Keane RM, Munster AM, Birmingham W et al. (1982) suppressor cell activity after major injury: Indirect and direct functional assays. J Trauma 22: 770–773

    Google Scholar 

  41. Kirkpatrick JR, Gobielle R (1977) Selective hyperalimentations: A new look at an old problem. J Trauma 17: 725–731

    Article  PubMed  CAS  Google Scholar 

  42. Kurzweg FT (1953) Pulmonary complications following upper abdominal surgery. Am J Surg 19: 967–970

    CAS  Google Scholar 

  43. Lanser ME, Saba TM (1979) Fibronectin as a co-factor necessary for optimal granulocyte phagocytosis of Staphylococcus aureus. J Reticuloendothel Soc 30: 415–424

    Google Scholar 

  44. Lidwell OM (1984) The cost implications of clean air systems and antibiotic prophylaxis in operations for total joint replacement. Infect Control 5: 36–37

    PubMed  CAS  Google Scholar 

  45. Lidwill OM, Lowbury EJL, Whyte W et al. (1982) Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: A randomized study. Br Med J 285: 10–14

    Article  Google Scholar 

  46. Lindsey D, Nava C, Marti M (1982) Effectiveness of penicillin irrigation in control of infection in sutured lacerations. J Trauma 22: 186–189

    Article  PubMed  CAS  Google Scholar 

  47. LoCurto JJ Jr, Swan KG, Tischler CD et al. (1986) Tube thoracostomy and trauma: Antibiotics or not? J Trauma 26: 1067–1072

    Article  PubMed  Google Scholar 

  48. Mac Leod CM, Hodges RG, Heidelbergr M et al. (1945) Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides. J Exp Med 82: 445–465

    Article  Google Scholar 

  49. Maki DG, Band JD (1981) A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter related infection. Am J Med 70: 739–744

    Article  PubMed  CAS  Google Scholar 

  50. Mandal A, Montana J, Thadepalli H (1985) Prophylactic antibiotics and no antibiotics compard in penetration chest trauma. J Trauma 25: 639

    Article  PubMed  CAS  Google Scholar 

  51. Mazaheri R, Rode HN, Abikar K et al. (1984) Dysfunction of humoral immunity in anergic surgical patients. Absence of anti-tetanus IgG antibody production. J Clin Immunol 4: 65–70

    Article  PubMed  CAS  Google Scholar 

  52. MgLaughlin GA, Wu AV, Saporoschetz I et al. (1979) Correlation between anergy and circulation immunosuppressive factor following major surgical trauma. Ann surg 190: 297–303

    Article  Google Scholar 

  53. Meakins JL, Pietsch JB, Bubenick O et al. (1977) Delayed hypersensitivity: Indicator of acquired failure of host defenses in sepsis and trauma. Ann Surg 186: 241–250

    Article  PubMed  CAS  Google Scholar 

  54. Morrison GE, Cunningham-Rundles S, Stahl WM et al. (1984) Augmentation of natural killer cell activity by a circulating peptide isolated from the plasma of trauma patients. Surg Forum 35: 164–166

    Google Scholar 

  55. Nehme AE (1980) Nutritional support of the hospitalized patient: The team concept. JAMA 243: 1906–1908

    Article  PubMed  CAS  Google Scholar 

  56. Nohr CW, Christon NV, Broadhead M et al. (1980) Failure of humoral immunity in surgical patients. Surg Forum 34: 127–129

    Google Scholar 

  57. Nohr CW, Christon NV, Rude H et al. (1984) Abnormal in vitro immunoglobulin production in surgical patients. Surg Forum 35: 146–148

    Google Scholar 

  58. Noon GP, Beall AC Jr, Jordan GL Jr (1967) Clinical evaluation pf peritoneal irrigation with antibiotic solution. Surgery 62: 73–78

    Google Scholar 

  59. Olson M, O’Connor MD, Schwartz ML (1984) A five year prospective study of 20,193 wounds at the Minneapolis VA Medical Center. Am Surg 199: 253–259

    CAS  Google Scholar 

  60. Oreskovich MR, Dellinger EP, Lennard ES et al. (1982) Duration of prevention antibiotic administration for penetrating abdominal trauma. Arch Surg 117: 200–205

    Article  PubMed  CAS  Google Scholar 

  61. Renk CM, Long CL, Blakemore WS (1982) Comparison between in-vitro lymphocyte activity and metabolic changes in trauma patients. J Trauma 22: 134–140

    Article  PubMed  CAS  Google Scholar 

  62. Rodehearer G, Bellamy W, Kody J et al. (1982) Bactericidal activity and toxicity of iodine containing solutions in wounds. Arch Surg 117: 181–186

    Article  Google Scholar 

  63. Robson MC (1979) Bacterial control in the burn wound. Clin Plast Surg 6: 515–521

    PubMed  CAS  Google Scholar 

  64. Robson MC, Heggers JP (1967) Bacterial quantification of open wounds. Milit Med 134: 19–22

    Google Scholar 

  65. Saba TM, Blumenstock FA, Scovill WA et al. (1978) Cryoprecipitate reversal of opsonic a2-surface binding glycoprotein deficiency in septic surgical and trauma patients. Science 201: 622–624

    Article  PubMed  CAS  Google Scholar 

  66. Sanders RA, Sheldon GF (1976) Septic complications of total parenteral nutrition. Am J Surg 132: 214–219

    Article  PubMed  CAS  Google Scholar 

  67. Schomof SC, Miller RM, Polakevetz S et al. (1974) Infection in the severely traumatized patient. Ann Surg 198: 352–357

    Google Scholar 

  68. Seropian R, Reynolds BM (1971) Wound infections after preoperative depilatory versus razor preparation. Am J Surg 121: 251–254

    Article  PubMed  CAS  Google Scholar 

  69. Shields RT Jr (1949) Pathogenesis of postoperative pulmonary atelectasis. An experimental study. Arch Surg 58: 489–492

    Article  PubMed  Google Scholar 

  70. Shires GT, Dineen P (1982) Sepsis following burns, trauma, and intra-abdominal infections. Arch Intern Med 142: 2012–2022

    Article  PubMed  CAS  Google Scholar 

  71. Singer DB (1976) Postsplenectomy sepsis. Perspect Pediatr Pathol 1: 285–311

    Google Scholar 

  72. Slade MS, Simmons RL, Yunis E et al. (1975) Immunodepression after major surgery in normal patients. Surgery 78: 363–372

    PubMed  CAS  Google Scholar 

  73. Stone HH, Fabian TC (1979) Management of perforation colon trauma; Randomization between primary closure and exteriorization. Ann Surg 190: 430–435

    Article  PubMed  CAS  Google Scholar 

  74. Stone HH, Symas PN, Hooper A (1981) Cefamandole for prophylaxis against infection in closed tube thoracostomy. J Trauma 21: 975–977

    Article  PubMed  CAS  Google Scholar 

  75. Stone HH, Hooper CA, Kolb LD et al. (1976) Antibiotica prophylaxis on gastric, biliary and colon surgery. Ann Surg 184: 443–450

    Article  PubMed  CAS  Google Scholar 

  76. Stratta RJ, Saffle JR, Ninnemann JL et al. (1985) The effect of surgical excision and grafting procedures on postburn lymphocyts suppression. J Trauma 25: 46–52

    Article  PubMed  CAS  Google Scholar 

  77. Sullivan MM, Sutter VL, Matlock MM et al. (1973) clinical aspects of bacteremia after manipulation of the genitourinary tract. J Infect Dis 127: 49–55

    Google Scholar 

  78. Superina RA, Christon NV, Meakins JL (1980) Failure of neutrophil delivery into skin windows in anergic surgical patients. Surg Forum 31: 68–70

    Google Scholar 

  79. Thadepalli H, Gorbach SL, Broido PW et al. (1973) Abdominal trauma, anaerobes and antibiotics. Surg Gynecol Obstet 137: 276–280

    Google Scholar 

  80. Tofurd P, Ristuccia P (1984) Recognition and control of outbreaks of nosocomial infections in the intensive care setting. Heart Lung 13: 486–495

    Google Scholar 

  81. Van de Water L, Destres AT, Hynes RO (1982) Fibronectin binds to some bacteria but does not promote their uptake by phagocytic cells. Science 220: 201–204

    Article  Google Scholar 

  82. Van der Linden W, Gedda S, Edlund G (1981) Randomized trial of drainage after cholecystectomy: Suction versus static drainage through a main wound versus a stab incision. Am J Surg 141: 289–294

    Article  PubMed  Google Scholar 

  83. Van Saene HKF, Stoutenbeek CP, Miranda DR et al. (1986) Recent advances in the control of infection in patients with thoracic injury. Br J Accid Surg 17: 332–336

    Article  Google Scholar 

  84. Verrier ED, Bossart KJ, Heer FW (1979) Reduction of infection rates in abdominal incisions by delayed wound closure techniques. Am J Surg 138: 22–28

    Article  PubMed  CAS  Google Scholar 

  85. Walker WE, Kapelanski DP, Weiland AP et al. (1985) Patterns of infection and mortality in thoracic trauma. Ann Surg 201: 752–757

    Article  PubMed  CAS  Google Scholar 

  86. Wang BS, Hepcock EG, Wu AVO et al. (1980) Generation of suppressor cells in mice after surgical trauma. J Clin Invest 66: 200–209

    Article  PubMed  CAS  Google Scholar 

  87. Warden GD, Mosan AD, Pruitt JB (1974) Evaluation of leukocyte chemotaxis in vitro in thermally injured patients. J Clin Invest 54: 1001–1004

    Article  PubMed  CAS  Google Scholar 

  88. Weinberg ED (1984) Iron withholding: A defense against infection and neoplasia. Physiol Rev 64: 65–102

    PubMed  CAS  Google Scholar 

  89. Wernick A, Jarstrand C, Julander I (1983) Effect of intralipid on mononuclear and polymorphonuclear phagocytes. Am J Clin Nutr 37: 256–261

    Google Scholar 

  90. Wilson RF, Soullier G (1980) The validity of two-hour creatinine studies in critically ill patients. Crit Care Med 8: 281–284

    Article  PubMed  CAS  Google Scholar 

  91. Wilson RF, Soullier G, Antonenko D (1979) Ionized calcium levels in ciritcally ill surgical patients. Am Surg 45: 485–490

    PubMed  CAS  Google Scholar 

  92. Ziegler EJ, McCutchan JA, Fierer J et al. (1982) Treatment of gram-negative bacteriemia and shock with human antiserum to mutant Escherichia. N Engl J Med 307: 1225–1230

    Article  PubMed  CAS  Google Scholar 

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Wilson, R.F. (1989). Prävention und Therapie der Sepsis bei operativen Risikopatienten. In: Reinhart, K., Eyrich, K. (eds) Sepsis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-09869-1_22

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