S2k-Leitlinie Gastrointestinale Infektionen und Morbus Whipple

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doi:10.1055/s-0034-1399337

Cited by 107 publications

(31 citation statements)

References 229 publications

(140 reference statements)

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“…1). These cases were then thoroughly reviewed by at least two independent internists (MM, AL, or PK) with regard to recognition and correct classification of sepsis (ACCP/SCCM definitions), adequate detection of the septic focus (history, examination, chest x-ray, urine dipstick, and eventually abdominal ultrasonography), empiric antibiotic regimen according to available national guidelines [13–16], appropriate fluid resuscitation and outcome (death, admission to an intensive care unit, length of hospital stay). In the event of disagreement, the case was discussed within the whole study team, and a final rating was set.…”

Section: Methodsmentioning

confidence: 99%

Sepsis recognition in the emergency department – impact on quality of care and outcome?

et al. 2016

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BackgroundAppropriate and timely recognition of sepsis is a prerequisite for starting goal-directed therapy bundles. We analyzed the appropriateness of sepsis recognition and documentation with regard to adequacy of therapy and outcome in an internal medicine emergency department (ED).MethodsThis study included 487 consecutive patients ≥18 years of age who presented to a university hospital ED during a 4-week period. Clinical, laboratory, and follow-up data were acquired independently from documentation by ED physicians. The study team independently rated quality of sepsis classification (American College of Chest Physicians/Society of Critical Care Medicine definitions), diagnostic workup, and guideline-adherent therapy in the ED.ResultsOf 487 included patients, 110 presented because of infection. Of those, 54 patients matched sepsis criteria, including 20 with organ damage and thus severe sepsis, as rated by the study team. Sepsis was not recognized in 32 of these 54 cases (59%). Multivariate binary logistic regression analysis revealed that higher systolic blood pressure (p <0.05), the ability to stand (p <0.01) and a low number of documented vital signs in the ED discharge letter (p < 0.05) were independent predictors of missed sepsis. Surprisingly, adequate detection of the septic focus (81 vs. 93%, p = 0.17), appropriate fluid administration (86 vs. 87%, p = 0.39), and guideline-adherent antibiotic regimen (95 vs. 100%, p = 0.42) did not differ between cases of recognized and unrecognized sepsis, respectively. Non-recognition affected neither death-censored length of hospital stay (median 7.63 d vs. 7.13 d, p = 0.42) nor a combined endpoint of death or ICU admission to (9 vs. 12%, p = 0.55).ConclusionsNon-recognition of sepsis in ED patients with serious infections who formally meet organizational sepsis definitions seems to have no deleterious impact on initial therapy adequacy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-017-0122-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Sepsis recognition in the emergency department – impact on quality of care and outcome?

et al. 2016

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“…Some of these differences can be explained by differences in the length of time of therapeutic monitoring, as relapses usually occur after several years, and thus, good estimates of these relapse rates can be reported only when long-term monitoring is performed. Late relapses can occur even after several years, and it is argued that patients should be monitored for life (62,227). Although there is evidence that relapses can be treated successfully using the same antibiotics that were used in the initial treatment (205,209), it may be prudent to change the antibiotic regimen when treating a patient with a relapse.…”

Section: Treatment Follow-upmentioning

confidence: 99%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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SUMMARY Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity. The development of molecular techniques has resulted in more convenient methods for detecting T. whipplei infections, and this has greatly improved the diagnosis of this often missed infection. In addition, the molecular detection of T. whipplei has resulted in an increase in knowledge about its pathogenicity, and this review gives an overview of the new insights in epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Tropheryma whipplei infections.

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“…In der Regel lässt sich eine bakterielle Infektion einem infizierten Organ oder einem Infektionsherd zuordnen Infektionen bei Immunsupprimierten stellen eine besondere diagnostische Herausforderung dar CME pie von Infektionen im Erwachsenenalter [3,4] oder in den Leitlinien der wissenschaftlichen Fachgesellschaften, u. a. zur Sepsis [5,6], zur ambulant erworbenen Pneumonie [7], zur nosokomialen Pneumonie [8], zu den Harnwegsinfektionen [9], zur Endokarditis [10], zu infektiösen Darmerkrankungen [11] oder zur Therapie der Helicobacter-pylori-Infektion [12].…”

Section: Indikationen Für Den Einsatz Von Antibiotikaunclassified

Rationaler Einsatz von Antibiotika

Walger

2016

Internist

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International and national campaigns draw attention worldwide to the rational use of the available antibiotics. This has been stimulated by the high prevalence rates of drug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), a threatening spread of development of resistance in Gram-negative rod-shaped bacteria and the selection of Clostridium difficile with a simultaneous clear reduction in the development of new antibiotics. The implementation of antibiotic stewardship programs aims to maintain their effectiveness by a rational use of the available antibiotics. The essential target of therapy with antibiotics is successful treatment of individual patients with bacterial infections. The optimal clinical treatment results can only be achieved when the toxicity, selection of pathogens and development of resistance are minimized. This article presents the principles of a rational antibiotic therapy.

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S2k-Leitlinie Gastrointestinale Infektionen und Morbus Whipple

Cited by 107 publications

References 229 publications

Sepsis recognition in the emergency department – impact on quality of care and outcome?

Sepsis recognition in the emergency department – impact on quality of care and outcome?

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Rationaler Einsatz von Antibiotika

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