Bacterial infection
| Classification according to ICD-10 | |
|---|---|
| A49.- | Bacterial infection of unspecified location |
| ICD-10 online (WHO version 2019) | |
Bacterial infection is the slang term for an infectious disease caused by bacteria that is always preceded by a bacterial infection .
General
In humans, the lining of the respiratory and digestive tract is very often affected. The organ with the highest incidence of bacterial infections is the skin itself due to its property as a border organ. Many bacterial infections are harmless, but can also lead to death, depending on the germ, where they occur and the host's immune system. Thus, tuberculosis and bacterial diarrhea still in the year by the WHO to find published mortality statistics far forward.
Due to the expected strong increase in COPD , with its two to three acute exacerbations per year, it represents an increasing problem, even if only some of the exacerbations are bacterial. The most common bacterial pathogens here are Haemophilus influenzae , Streptococcus pneumoniae , Moraxella catarrhalis , Enterobacteriaceae and Pseudomonas aeruginosa .
Diagnosis
The diagnosis is usually made in the private practice solely by taking anamnesis and assessing the general condition of the patient. The exact determination of the pathogen is only possible through the appropriate bacteriological laboratory diagnostics . Swab , obtaining a secretion or Punktats (as part of a bronchial lavage or lumbar puncture ), and in the case of sepsis the blood sample as possible of the extraction material serve fever during the thrust. The choice of the right transport medium and the transport note to be filled out as completely as possible with details of the question to be addressed to the laboratory physician are further indispensable prerequisites for cultivation and identification of the pathogens as well as the testing of the sensitivity of germs to different antibiotics in the laboratory.
In medical practice, determining the CRP can help distinguish between (deep-seated) bacterial infections and inflammations / infections of other causes, but it can neither replace a medical examination nor significantly reduce the number of antibiotic prescriptions by resident doctors.
The determination of the procalcitonin concentration in the serum can enable a faster diagnosis , at least in the case of sepsis .
therapy
Bacterial infections are usually treated with antibiotics , whereby the patient's history of allergic reactions and the respective local resistance situation must be taken into account when deciding on treatment. Bacteria resistant to antibiotics can be treated with bacteriophages (see phage therapy ).
In medical practice, due to the acute need for action and cost efficiency, a pathogen determination is generally dispensed with. In addition to the knowledge of the doctor, a large amount of so-called "medical art" is required. Because after the differential diagnostic question of whether the current problem is a bacterial infection at all and the administration of antibiotics is necessary in principle, further decisions are necessary:
- Does the detection of bacteria (in the case of a urine examination, for example, the detection of blood and nitrite in the case of a urinary catheter ) require the administration of an antibiotic in this case?
- which antibiotic (or which combination of antibiotics)?
- in what dosage, frequency and duration?
- in which form of administration?
Examples of emergencies that require intravenous antibiotics are acute meningitis , Waterhouse-Friderichsen syndrome , any other form of bacterial sepsis, and advanced pelvic inflammation . The osteomyelitis is due to poor blood circulation caused Knochengängigkeit of most antibiotics is a problem. The situation is similar in infections on the floor of circulatory problems arise such. B. in diabetic foot syndrome . In principle, erysipelas is a self-limited disease, but the high tendency to recur with the risk of obliteration of lymph vessels and the development of lymphedema requires high-dose intravenous penicillin administrations .
Multiple resistances of various bacteria, such as the so-called MRSA ( methicillin- resistant Staphylococcus aureus) make treatment more difficult and expensive and pose great challenges for organization in hospitals and nursing homes.
prophylaxis
Various measures are used to prevent bacterial infections:
hygiene
A great deal of attention must be paid to hygienic regulations and, in particular, to hospital hygiene. The aim of the latter is to minimize the number of so-called nosocomial infections occurring in hospitals . Such infections can be expected in an average of 3.5 percent of all hospital stays lasting longer than 48 hours. Urinary tract infections , pneumonia , wound infections after surgical interventions and sepsis are in the foreground.
Vaccinations
Vaccinations against bacterial pathogens themselves only offer incomplete protection. The period of protection for the vaccine against Haemophilus influenzae is estimated to be three to seven years, similarly likely to pertussis (whooping cough). The BCG vaccination against tuberculosis is not, however, recommended in Austria for countries with high incidences as a highly cost-effective measure against severe childhood tuberculosis. For vaccinations against cholera and typhus see there.
The situation is different with tetanus and diphtheria , where vaccination against the toxin of the bacteria is carried out (see toxoid vaccines ).
Reinfection prophylaxis
In order to prevent damage from reinfection , forms of infection prophylaxis are carried out in the case of recurrent urinary tract infections and endocarditis .
See also
Individual evidence
- ↑ Fritsch: Dermatology and Venereology. Springer textbook, 2nd edition, Springer, Berlin a. a. 2004, ISBN 3-540-00332-0
- ^ GC Donaldson et al .: Longitudinal changes in the nature, severity and frequency of COPD exacerbations. In: The European Respiratory Journal (ERJ) Vol. 22, 2003, pp. 931-936. ( Full text online)
- ↑ AWMF online: Treatment of adult patients with community-acquired pneumonia. accessed on March 10, 2018
- ↑ On the near-patient CRP measurement in the private practice - Can the CRP measurement in private practice help to reduce antibiotic prescriptions? - An assessment. Austrian Academy of Sciences - Institute for Technology Assessment, 2000. Full text as PDF
- ^ Fritz H. Kaiser, Erik C. Böttger, Rolf M. Zinkernagel, Otto Haller, Johannes Eckert, Peter Deplazes: Pocket textbook medical microbiology. 11th edition, Thieme, 1969/2005 , ISBN 3-13-444811-4
- ↑ BCG vaccination highly cost effective. The Lancet, press release April 7, 2006
