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Diagnose der Infektion und Stellenwert von Biomarkern

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Sepsis und MODS

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Zusammenfassung

Der Übergang einer lokal begrenzten Infektion zu einer schweren Sepsis lässt sich nach wie vor nicht sicher vorhersagen. Die hohe Letalität und Morbidität der Sepsis könnte durch eine frühzeitigere Diagnose gesenkt werden. Der Erregernachweis durch die Blutkultur ist trotz niedriger Positivitätsrate für die antimikrobielle Therapie unabdingbar. Blutkulturdiagnostik und Präanalytik weisen jedoch erhebliche Defizite auf.

Der Erregernachweis über Nukleinsäure-Amplifikationstechniken ohne kulturelle Voranreicherung wird zzt. als vielversprechender Ansatz im frühen Stadium der Sepsis diskutiert. Mangelnde Sensitivität und Spezifität, ein auf wenige Targets beschränkter Resistenznachweis sowie eine lange „time to result“ schränken den klinischen Nutzen deutlich ein. Sepsismarker erhöhen die diagnostische Präzision, müssen aber wie alle Labormarker im klinischen Kontext interpretiert werden. Procalcitonin (PCT) ist trotz vieler Einschränkungen der derzeit am besten geeignete Marker.

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  1. Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    Prof. Dr. med. Frank M. Brunkhorst

  2. Paul-Martini-Forschergruppe für Klinische Sepsisforschung, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    Dr. rer. nat. R.P.H. Schmitz

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  1. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle(Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle(Saale), Germany

    Karl Werdan

  2. Lehrstuhl für Geriatrie, Charité-Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Berlin, Germany

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  4. Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Germany

    Frank M. Brunkhorst

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Brunkhorst, F., Schmitz, R. (2016). Diagnose der Infektion und Stellenwert von Biomarkern. In: Werdan, K., Müller-Werdan, U., Schuster, HP., Brunkhorst, F. (eds) Sepsis und MODS. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45148-9_2

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