Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
Review[Antibiotic Stewardship and Infection Control - Two Pages of a Coin].
According to public awareness, high rates of multiresistant organisms in healthcare facilities are mainly associated with two terms: "Hospital" and "Infection control problem". The use of antibiotics in ambulatory and hospital care is probable at least as important or even more important. ⋯ Microbiome research will lead to a better understanding of this relationship and may provide new measures for preventing the spread of multiresistant organisms. The available data underline the need of a close interaction between antibiotic stewardship and infection control.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
[Antibiotic Stewardship - From Bench to Bedside].
The article explains the practical implementation of Antibiotic Stewardship (ABS) in the clinic. With increasing prevalence of resistant bacteria, the medical profession is challenged to critically question and reduce antibiotic prescriptions. ABS programs are designed to support this. ⋯ Microbiological pre-analysis is of crucial importance. In this case, fewer swabs, but more meaningful analytical methods, such as blood cultures or invasive probes, must be attempted. Finally, interactions between clinicians, microbiologists and hospital hygienists are of great importance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
[Antimicrobial Stewardship in Daily Life - "Ask Your Doctor and Your Pharmacist"].
Antimicrobial Stewardship (AMS) cannot be practised as a one-man show. A well-established AMS-team with formal authority and dedicated time given by the hospital management can manage its tasks also in exceptional situations as for example an outbreak due to a multi-drug-resistant pathogen. Know-how of clinical infectious diseases is mandatory for all members of the AMS-team. ⋯ Restrictive usage of antibiotics can decrease the antibiotic selection pressure and counteract with the development of new bacterial resistances. Usage of last-resort antibiotics in an outbreak situation leads to an exceptional increase of therapeutic costs with fewer patients at the same time. Interdisciplinary work of infection control, the AMS-team, the different clinical departments and the hospital management are important for the prevention and the management of outbreak situations due to multi-drug-resistant pathogens.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
Review Case Reports[Management of Massive Intraoperative Blood Loss Using a Case Study].
Massive intraoperative bleeding is a major and potentially life-threatening complication during surgical procedures. The lethal triade of hemorrhagic shock with metabolic acidosis, hypothermia and coagulopathy enhances bleeding tendency. ⋯ Primary goals include the maintenance of adequate tissue oxygenation, restauration of proper coagulatory function, normothermia and homeostasis of acid-base and electrolyte balance. In the present article, these therapeutic goals and their pathophysiological background are illustrated with a clinical case example.