Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Prevalence of Multidrug-Resistant Organisms (MDROs) varies temporally, geographically, and by healthcare setting. In general MDROs rates are higher in hospitals compared to the outpatient setting. Within the hospital the prevalence of MDRO-patients in ICUs is higher than in non-ICU wards. While the number of MRSA-patients decreased over the last years, there was a continuous increase of Gram-negative bacilli (GNB) in Germany. At present, every 60. patient in the ICU is known as colonized or infected with GNB. ⋯ MDROs may increase healthcare costs as well as patient morbidity and mortality.
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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. ⋯ 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.
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The adequate management of infections is an important task in critical care medicine which has an effect on patient outcome. As a result, the prevalence of antiinfective therapy is high in intensive care units. In the face of an unsettling development of worldwide microbial resistance, an optimization and reduction of antiinfective therapy is necessary. ⋯ One overall objective of antibiotic stewardship is the reduction of resistance induction in order to preserve the therapeutic efficiency of antibiotics. Intensive care units are important fields of action for antibiotic stewardship interventions. This article reviews available evidence and some practical aspects for antibiotic stewardship.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2016
Review[Prehospitale analgesia in adults].
After securing vital function, treatment of pain is an important aspect in emergency medical care. Irrespective of the underlying disease or injury, pain is an important warning symptom of the body and the most common reason for an emergency alert notification. A patient assesses quality of care and success of prehospital care using the criteria of the extent of pain relief he experiences. ⋯ Above a grade of 4, therapeutic intervention should be initiated with the goal of reducing pain to reach a value of <4, or at least to achieve a reduction by 3 points. The choice of analgesics that can be meaningfully used in pre-hospital emergency medicine is limited. The emergency physician should be aware of available drugs and administration routes.