Therapeutic target
- Rehabilitation or cure of the patient
Therapy recommendations
- MRE (multidrug-resistant pathogens): isolate patient (single room; surgical face mask; work procedures according to infection control manual) [critics of isolated rooms point out that isolation units often increase bacteremia rates due to contamination of glove boxes → with disposable gloves, pathogens are passed via intravenous injection].
- In complicated infections consil with microbiologist / infectiologist.
- Multi-resistant gram-negative pathogens (MRGN),
- That are resistant to the 3 antibiotic groups fluoroquinolones, piperacillins, and 3rd generation cephalosporins: Therapy with carbapenems
- Who are resistant to the 3 mentioned and carbapenems: Combination of a carbapenem with a carbapenemase inhibitor (Vabomere, this contains once meropenem, a carbapenem approved as a single substance since 1997, combined with vaborbactam, which belongs to the beta-lactamase inhibitors).
- Therapy for MRSA:
- Strain haMRSA (for “healthcare associated”): reserve antibiotics are linezolid and quinupristin/dalfopristin. Combination of cotrimoxazole and rifampicin or clindamycin and rifampicin.
- Strain caMRSA (“community-acquired”; these are MRSA occurring outside the hospital): Reserve antibiotic is linezolid. Smaller solitary furuncles should also receive systemic antibiotic treatment for caMRSA.
- Sanitation: For decolonization of haMRSA and caMRSA; duration of sanitation measures: 5 days.
- Nasal vestibules: 3 x daily mupirocin nasal ointment.
- Throat: gargle 3 x daily with 0.1% chlorhexidine solution or octenidine solution.
- Skin and hair: 1 x tgl: disinfection, ie showering or full body care including hair washing with suitable disinfecting wash lotion (eg Octenisan wash lotion).
- Wounds: 3 x daily octenidine, for smaller lesions (< 3 cm2) also mupirocin ointment.
- Surface disinfection of the shower / tub after each use.
- To prevent recolonization during sanitation:
- Daily change of bed linen, clothing and personal hygiene utensils (towels, washcloths).
- Personal items (eg, razors) are to be disinfected or replaced after use. Waiver of roll-on deodorant.
- Control of the success of sanitation for MRSA:
- First control smear after a treatment break of at least 48 hrs. (avoid false-negative results).
- In MRSA-negative smear (preliminary sanitation success): control smears after 3-6 and after 12 months.
- Other “Drug therapy“: see under the respective disease.
Further notes
- Ureidothiophene carboxylic acids, a novel class of compounds is effective against both HIV and methicillin-resistant Staphylococcus aureus (MRSA). However, extensive studies and development work are still required before clinical application becomes possible.
