Infektionsprophylaxe bei gastrointestinalen endoskopischen Eingriffen

 

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Zusammenfassung

Bei endoskopischen Untersuchungen des Gastrointestinaltrakts kommt es häufig zu transienten Bakteriämien, allerdings nur sehr selten zu manifesten Infektionen. Trotzdem wird für ausgewählte Risikopatienten eine Antibiotikaprophylaxe empfohlen. Bei Patienten mit einem hohen Endokarditisrisiko (z. B. Klappenträger, Z.n. vorangegangener Endokarditis, angeborene zyanotische Vitien) sollte eine Antibiotikaprophylaxe mit Amoxicillin (Clindamycin oder Vancomycin bei Penicillinallergie) durchgeführt werden. Auch Patienten mit gestauten Gallengängen, bei denen eine endoskopische retrograde Cholangio-Pankreatikografie (ERCP) durchgeführt wird, sind, genauso wie Patienten vor der Anlage einer perkutanen endoskopischen Gastrostomie (PEG), Kandidaten für eine Antibiotikaprophylaxe. Patienten mit Leberzirrhose und endoskopischer Behandlung einer Ösophagusvarizenblutung benötigen ebenfalls eine antibiotische Therapie. In der Übersicht wird auch auf die Patienten, die keine Prophylaxe benötigen, eingegangen.

Summary

Transient bacteraemia during endoscopic examination of the gastrointestinal tract is well recognized, but infectious complications arising from such transient bacteraemia are rare. Nevertheless, patients at high risk should receive antibiotic prophylaxis. Patients with an increased risk for endocarditis (e. g. patients with a prosthetic heart valve or a history of endocarditis) should receive amoxicillin (clindamycin or vancomycin when allergic to penicillin) prophylactically. In addition, patients with cholestasis undergoing endoscopic retrograde cholangiopancreatography and those before percutaneous endoscopic gastrostomy should receive antibiotic prophylaxis. Patients with cirrhosis of the liver and endoscopic treatment of bleeding esophageal varices should be treated with antibiotics as well. Patients who do not need antibiotic prophylaxis will also be defined in this review.

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Dr. med. Dr. phil. Erwin Biecker

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