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Antibiotische Therapie

  • Hartmut Lode

Zusammenfassung

Für die Pathogenese der infektiösen Endokarditis sind mehrere Faktoren im Verlauf der Entstehung der spezifischen Infektion von Bedeutung: Veränderungen des Herzklappenendothels mit Begünstigung der mikrobiellen Adhärenz, Adhäsionseigenschaften der zirkulierenden Bakterien, die die Haftung an derartigen Klappenoberflächen bedingen, und die Fähigkeit der Erreger, an diesem Endothel sich nicht nur zu vermehren, sondern auch eine entzündliche Vegetation zu induzieren (siehe Kap. 2) (4, 16, 81). Das Ergebnis dieser Abläufe sind zunächst die charakteristischen thrombotischen Vegetationen an den Klappenrändern, die als nichtbakterielle thrombotische Endokarditis (NBTE) beginnen und sekundär mikrobiell besiedelt werden. Die sich entwickelnden Vegetationen bestehen mikroskopisch aus amorphem Material, welches sich aus Fibrin, Thrombozyten, Leukozyten und Erythrozyten bzw. deren Restbestandteilen zusammensetzt, zusammen mit riesigen Bakterienmassen. Experimentelle Befunde belegen Bakterienzahlen bis zu 109 – 1010/g Gewebe (69). Darüber hinaus wurde nachgewiesen, daß Streptokokken tief innerhalb der Vegetationen eine verminderte synthetische metabolische Aktivität aufweisen (17). Zu beachten ist weiterhin, daß die Herzklappen normalerweise nur an ihrer Basis vaskularisiert sind und daher Antibiotika nur über den Blutstrom per Diffusion an die Bakterien in die Klappenvegetationen transportiert werden können. Weiterhin können Destruktionen oder entzündliche Nekrosen im Sinne von Abszeßbildung an den betroffenen Klappen entstehen.

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© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1994

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  • Hartmut Lode

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