Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Tarragona strategy--appropriate antibiotic therapy in the ICU].
Appropriate antibiotic initial therapy remarkably decreases the mortality of patients with infections in the ICU. The establishment of an appropriate initial therapy follows empirical aspects. This practice was first done for the treatment of nosocomial pneumonia. Since that time the practice became known as Tarragona strategy. ⋯ This procedure is safe, reduces mortality, limits the development of resistance, and is economic.
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Emergency and intensive medical care of status epilepticus].
Convulsive status epilepticus is defined as a general or focal epileptic seizure lasting longer than 5 min or recurrent seizures without regaining consciousness between seizures. Status epilepticus is a life-threatening condition caused by underlying pathologies (e.g., stroke, meningitis, cerebral hypoxia, cerebral edema). In addition, patients are in danger of physical injury and impaired brain stem reflexes. ⋯ Benzodiazepines are the first choice treatment for status epilepticus. This article summarizes a guideline-directed therapy with different pharmaceutical substances and ways of application. A pragmatic approach for limited diagnostic and therapeutic possibilities in the emergency situation is presented.
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Selection of the optimal antimicrobial therapy is often crucial for the morbidity and mortality associated with an infection. A reliable antibiogram provides the basis for antibiotic therapy optimization. In case of life-threatening infections, minimal inhibitory concentration values should be available so that, in conjunction with knowledge of the pharmacokinetic properties of the respective antibiotics, a rational selection addressing the individual case is feasible. If only categorized results (susceptible, intermediate, resistant: S-I-R) are available, they should be established according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines in order to avoid therapeutic failures.
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Tissue penetration of antibiotics. Does the treatment reach the target site?].
For critically ill patients, infections still imply a major challenge for the treating physician. One key factor of successful treatment is sufficient exposure of the employed antimicrobial agent at the site of infection. In most cases, this is the interstitial space of the infected organ or a body cavity; much rarer vital bacteria are located within body cells. ⋯ In order to use pharmacokinetic data to optimize the treatment of critically ill patients, critical appraisal of the causative pathogen, the location of the infection, and the source of the used pharmacokinetic data is necessary.
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Diagnostic markers and assessment of efficacy of antibacterial therapy].
In anti-infective therapy, there is a need for objective diagnostic markers to guide the appropriate selection and duration of antibacterial treatment. In the diagnosis and treatment of bacterial infections, three aspects must be considered: the appropriateness of antibacterial therapy, the initiation and evaluation of an effective initial therapy, and termination of the antimicrobial treatment. Repetitive monitoring of procalcitonin (PCT) has been proposed as such a marker in conjunction with the clinical presentation and microbiological sampling of blood, urine, and/or sputum. ⋯ Examples are calcitonin-producing tumors, medullary C-cell thyroid carcinoma, and acute respiratory distress syndrome (ARDS). PCT can also be elevated in fungal infections. On the other hand, localized and encapsulated infections (e.g., abscess, endocarditis and early stages of infections) can be associated with lowered PCT values.