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Many bacteria are becoming increasingly resistant to antibiotics. But in the meantime &Auml prescribe;the means of doctors thoughtful and more focused than even a few years ago. In other areas, a change in thinking takes place

Researchers are testing resistance with Antibiotikapläleaves on a Näbreeding ground for. The effect of the substance, wäfirst of all, it grass not a Bacteria

Week &Auml knew;doctors in GroßBritain is not whether you k&ouml help your patients;can. The man had last Winter on a Südost­trip to Asia with the sexually transmitted disease gonorrhea (Gonorrhö) plugged – a bacterial infection with purulent discharge, pain and Burning during urination. No antibiotic relieved the discomfort. It was the world’s first infection with gonorrhea pathogens (gonococcus), which responded to none of the usually effective means.

Schließlich ver­­the &Auml abreichten;a Carbapenem doctors, a substance to Bekäcombat other bacterial pathogens. With Success. In April, finally the message: The man is healed. The grundsäadditional Problem, however, remains: more and more bacteria are not more of antibiotics "beeindrucken". They are resistant to the active ingredients. Für the affected patients means that There are few or no drugs that can help you.

In some infections, the Reserve failure-antibiotics

Already at the beginning of 2017 veröpublished by the world health organization (WHO), a list of ten bacteria against which new antibiotics are most urgently benöbe taken. To many agents adapted gonococcal zämiss. However, the hömost Priorität is für resistant variants of bacteria to our healthy natünatural Flora gehören: the intestinal bacterium Escherichia coli.

The Problem is, these microbes, if they cause infections. You threaten, especially severely ill and immuno-compromised patients in hospitals. Antibiotics to keep the Infected from serious Verlächeck to death. Sometimes the last means of so-called Reserve antibiotics, which include carbapenems z&auml failure even;miss. Because such Fälle in the world are on the increase, warns the WHO in front of a post-antibiotic era – a Situation in which gewösimilar bacterial infections are a threat.

"To Glück, we are in Germany of such a scenario, still a good Stück. The vast majority of patients köwe can behandeln", Dr. Tim Eckmanns, Epidemio&shy says;Lodge at the Robert-Koch-Institute in Berlin. "But sometimes &Auml have;doctors in this country only two, one, or no effective antibiotic in the Hand." Up to 4000 people die in Germany jäannually of infections with multi-resistant bacteria, schäexperts will appreciate. Für, Eckmanns still there’s no reason for the black painting: "We köcan very much do to the verfüavailable antibiotics läto keep the Viking effect."

Maßtook für a meaningful use of antibiotics in clinics

Äsimilar to Dr. Katja de With, head of the Department of f&uuml sees it;r Clinical In­­fektiologie at the University hospital of the Technical Universität Dresden: "Üeverywhere in the world to take resistance. But we köcan prevent you from außhe was out of control." However, müsse itself dafür a lot of ächange. In Germany, it was made a lot lately. For example, with so-called "Antibiotic Steward­ship"-Programs in Krankenhäusers.

Is meant to be a Bübundle of Maßtook to medicines for Bakte­rien so that the bestmöaligned therapy success bring – without the dissemination of resistance to föpromote. "I have no clinic is well-known, the not improvements bemüht", de With says. The pharmacist, internist, and infectious disease login coordinates the training für medical personnel. Together with other experts, she has außalso a guideline for the vernüfuture use of antibiotics in hospitals was developed.

What l&auml reach;sst, if you implement the guidelines consistently, could de With show. Her Team reduced the antibiotic consumption at the University hospital Dresden in füfive years of 20 percent. The so-called infectiology ward rounds in intensive care units have played a key role. De With: "We überprüfen für each patient, why he gets antibiotics. If we see no reason, we finish the therapy."

Targeted treatment when the pathogen is identified

What needs to be done in a particular case, decides to de With together with the Ädoctors, micro-biologists and pharmacists in the clinic. Often, the medication is adjusted. Background: Many patients get zunäfirst of all, Antibio­internship, without the cause of the infection is not known. If the Laborunter­search the pathogen später have identified, can be targeted in treatment.

For example, ­against pneumococci with a Lungenentzümaking. "In contrast, benzyl penicillin is still the best Me­dikament, if the bacteria ansprechen&quot it;, de With says. Benzyl penicillin is one of the äone of the oldest still-used group of antibiotics. It is the substance, which the Scot Alexander Fleming in 1928 from a fungus isolated – the beginning of the antibiotic era. A further advantage of Penizillinen: you will drive the development of resistance less rapidly than many später developed antibiotics.

Less side effects by sorgfävalid antibiotic-use

But sorgfäRenova therapy decisions not only reduce the risk of invincible agents, they also reduce the side effects für patients: about Durchfälle, abdominal pain, Ünausea and allergic reactions. A particularly gefürch­tete a result of antibiotics-are gifts Darmentzündungen, caused by Clostridium difficilebacteria. You köcan be very difficult to run and even töSouth. Clostridium difficile thrives especially well if ­Drugs the ürest of the gut flora ­­geschähave damaged.

In the case of therapies with so-called fluoro-quinolones and the newer cephalosporins, particularly h&auml happens;frequently. "We have the use of these antibiotics in the last four years in our clinic strongly eingeschränkt", Professor Mathias Pletz, Director of the Institute f&uuml says;r infection medicine and hospital hygiene at the University hospital of Jena and member of the management Board of the German society für infectious diseases. With success: The number of Clostridium difficile caused Darmentzüinventions dropped to 60 percent.

To a lot of Reserve antibiotics in the outpatient setting

Cephalosporins and fluoroquinolones are not intended for the treatment of serious bacterial infections when other agents act. But also established Ädoctors in Germany ver­arrange auffäcompletely häfrequently. "We use Reserve antibiotics in the outpatient area to be clueless. Läas Sweden has almost come without you aus", Pletz criticized.

But there is also a pleasing development in established Ädoctors: Since 2008, decreased their antibiotic ­Regulations in children 33, Säuglingen by 51 percent. This shows an analysis of the KaufmäFinnish health insurance. Ädoctors dispense about with feverish Erkältungen ömore often than früon a recipe. With good reason: Because most viruses are the cause. ­Antibiotics are effective only against bacteria.

Everyone can contribute something, that resistance to antibiotics continue to increase. How you can find out in the Video

Guidelines to help in deciding whether the clinical picture of a patient für or against an antibiotic is talking about. Also blood tests köyou can have more clarity. They measure substances in the blood by bacterial pathogens erhöhen. Infection expert Pletz: "Studies show that these Tests can be saved in patients with respiratory 40 percent of infections to antibiotics." However, established Ädoctors use the Tests only rarely. Because a lab analysis is required, the result only after one to two days. And rapid tests that the doctor in his practice durchführt will not be refunded to cover costs of the funds.

Animal medicine and Abwäwater as further sources of problems

Experts agree: There is a lot of room f&uuml remains;r further improvements – also in veterinary medicine. Here are the antibiotics used in f&uuml managed;five years to üabout the Häto lower half. Undoubtedly a success. "However, Colistin is the antibiotic, the animals at the vierthämost common is prescribed. Thus, the resistance to rise against this Mittel", Eckmanns says. Him wäit re like most, you würde Colistin from animal medicine to banish. Because fücertain infections in humans, it is the last Reserve.

How far Colistin-resistance, widely used, show the latest data of the Institute für Hygiene and Öpublic health at the Universitätsklinikum Bonn. It is analyzed in German Abwäwaters multi-resistant bacteria, the emergency list is available on the WHO-at the very top. Result: In stämunicipal Abwäwaters were 28 percent against four classes of Drug-resistant – Carbapenems including. Almost 10 percent were zusäaddition of Colistin to be adjusted. Für the head of the Institute, Professor Martin Exner, resulting from new Ansätze für the Eindäresult of resistance: "Previously, it was thought, the human or the animal is the source. But obviously Abw&auml play;sser für the load on the environment, and the müwe left küin the future berüto be taken into account."

In KläRS held a lively exchange of drug resistance

It ünot surprised, then, that multi-drug resistant variants in Flüsse, and even in lakes. The extent to which municipal KläRS are suitable to remove resistant bacteria is the subject of current research. The project, the Exner coordinated, is expected to be completed in 2019. Then the participating experts want to make recommendations.

One result is already clear now: In KläRS finds among bacteria, there is a lively exchange of genetic material with resistance to information – üabout Species boundaries. And also f&uuml is;r the Abwässer of Krankenhäusers. There is, in fact, that you für patients to a Problem. How about in a Hessian hospital for a good four years. On 133 patients to a variety of intestinal bacteria, all with the same resistance characteristic f&uuml found;r carbapenems.

Exner’s Team was asked to help. After painstaking detective work, it turned out: bacteria in the Wasserablächeck the patient’s room, the origin of the resistance. Spirals, with those clogged pipes freigeräumt, spread the microbes to the Spüle the Küche. From there they came to eat. The outbreak turned out OK. The bacteria were a little infektiös and the patient in fairly good health. The example shows, however, the importance of a consistent Hygiene in all areas of hospitals is to prevent infections and resistance einzudäthe right to decide.

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