Carbapeneme wie Meropenem (nicht Ertapenem) gelten als wichtige Stützpfeiler für die Behandlung von Acinetobacter- baumannii-Infektionen.
In einer deutschlandweiten Studie wurde eine gepoolte Rate von 20,8 % (95 %-CI: 15,6–26 %) Carbapenem-nicht-sensib-len Acinetobacter baumannii-Isolaten gefunden, von denen 83,7% eine OXA-23-like-Carbapenemase produzierten. Der
MDR- und XDR-Stämmen (Tabelle 6) (Sader et al. 2018 u.
2019). Gleiches gilt für Colistin und das kürzlich zugelassene Cefiderocol (Doi 2019). Bei Pseudomonas aeruginosa-Kollek-tiven mit 30 % nicht-empfindlichen Stämmen gegenüber Pi-peracillin-Tazobactam und Meropenem erwiesen sich 95,9 % bzw. 95,0 % als Colistin- bzw. Ceftazidim-Avibactam-sensibel (Hackel et al. 2019).
Anteil resistenter Isolate erhöhte sich von 20,3 % im Jahr 2010 auf 32,3 % im Jahr 2013 und nahm im Jahr 2016 bis auf 13,4 % ab (Chi-Quadrat-Test für linearen Trend, p=0,2) (Kresken et al. 2019). Die Antibiotikatherapie sollte nach Testung und ggf. in Kombination mit Colistin erfolgen.
Als weiteres Antibiotikum mit guter In-vitro-Wirksamkeit bei Acinetobacter baumannii steht seit kurzem Cefiderocol zur Verfügung (Doi 2019).
Erreger
(Anzahl getestet)
empfindlich (%) Ceftazidim/
Avibactam Ceftolozan/
Tazobactam Meropenem Piperacillin/
Tazobactam Pseudomonas aeruginosa
(n=6210) 97,1 97,0 78,2 79,1
MER-NS (n=584) 74,5 76,8 0 0
MDR (n=1285) 86,1 86,8 24,9 21,9
XDR (n=810) 80,1 80,7 13,5 8,8
Tabelle 6: In-vitro-Wirksamkeit verschiedener Beta-Laktam-Antibiotika gegenüber P. aeruginosa isoliert von Patienten in US Kliniken (Sader et al. 2020).
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