Hygiene & Medizin
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Hygiene & Medizin 4/2012
Review
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Antimicrobial therapy of intra-abdominal infections due to resistant bacteria in patients with morbid obesity
Christian Eckmann, Peter Kujath, Hodjath Shekarriz
Morbid obesity is a well known risk factor for the development of postoperative infectious complications. Intra-abdominal infections (IAI) account for the majority of those infections. In most cases, treatment consists of a surgical source control and the concomittant application of antibiotics. IAI are mainly of polymicrobial origin. The group of patients with IAI suffering from resistant bacteria comprises the entire group of postoperative and tertiary peritonits. Bacteria of concern are Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and Carbapenem-resistant organisms (as well as occasional mycoses?). Especially with regard togram-negative bacteria, only few treatment options remain. This article provides information on the management of a very important group of diseases with a substantial morbidity and mortality, including considerations about antibiotic stewardship measures.
HygMed 2012; 37 [4]: 118–123
From the Field
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Important aspects in outpatient surgeries
Julia Okpara-Hofmann
According to section 36 (since 28th July 2011 now section 23) of the Act on the Prevention and Control of Infectious Diseases in Humans (Protection against Infection Act) institutions for outpatient surgery are subject to inspections by the public health services. The underlying principle is that an operation performed in an outpatient surgery should not be associated with a greater risk of infection than an operation linked with a hospital stay. Ten years have passed since the enactment of the Protection against Infection Act. However, during the inspections by the Public Health Service in institutions for outpatient surgery, certain important deficits with respect to infection control are still found. The inspections show, for example, that the information provided by the Federal Medical Council or the respective state medical associations is either not noted or not implemented by some of the institutions for outpatient surgery. There still is the need for the Public Health Service to advise institutions for outpatient surgery with respect to organisational structure, the process and outcome quality based on the recommendations of the commission for hospital Hygiene and Infection Prevention and to monitor the implementation of infection control measures. The operators of such institutions must recognize their own responsibility and deficits in infection control and learn to initiate corrective measures on their own. The article shows a brief overview of the relevant statutory provisions and the technical bases. Then the infection control inspection performed by the department of public health in the city of Cologne in institutions of outpatient surgery is described and common examples for critical aspects in infection control are illustrated.
HygMed 2012; 37 [4]: 124–130
