ANTIINFECTIOUS STRATEGIES ON THE ICU - THERAPEUTIC RECOMMENDATIONS FOR INTRAABDOMINAL AND CATHETER-RELATED INFECTIONS

I. Peritonitis Patients and methods: In a prospective protocol a diffe rentiated surgical and antibiotic treatment was evaluated on 53 consec utive patients with a diffuse peritonitis, treated in the Department o f Surgery of the RWTH in Aachen (ERG) from January 1996 to December, 1 997. Stage-I-peritonitis (MPS 0-20) was treated with the so-called sta ndard procedure (n = 17), Stage-II-cases (NIPS: 21-29) with the closed postoperative lavage (n = 21), and severe stage-III-cases (MPS >29) w ith the so-called ''Etappenlavage'' (multiple reexplorations and intra operative lavage [n = 15]). The stage-related antibiotic regimen was a combination of cefotaxime and metronidazole for stage-I- and stage-II -patients. In stage-II-patients 2 x 200 mg ofloxacin was added. Result s: Mortality was 0 % in stage-I-, 10 % (2/21) in stage-II-, and 33 % ( 5/15) in stage-III-patients. The overall mortality of the whole group was 13 % (7/53), while the statistically expected mortality was 25 % a ccording to the APACHE-II-Score (p <0.05). II. Catheter-related infect ions: Scenario: The critical ill patient has a high risk of acquiring a nosocomial infection. The need for invasive monitoring compromises t he host defenses in addition to the underlying disease and the treatme nt which encourages the growth of multiple resistent gram-positive bac teria - especially in catheter-related infections. In three quarters o f all cases these severe infections are caused by polyresistant CNS, w hich may only be susceptible to glycopeptides. If the device cannot be removed easily, teicoplanin is the adequate choice of treatment. High eradication rates and good tolerability are the rational for this rec ommended therapeutic regimen.