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„Beyond antibiotic therapy“ – Zukünftige antiinfektiöse Strategien – Update 2017

Beyond antibiotic therapy – Future antiinfective strategies – Update 2017

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Zusammenfassung

Hintergrund

Die wichtigsten Säulen der Therapie von „surgical site infections“ (SSI) sind heute die chirurgische Sanierung und die lokale bzw. systemische Antibiotikatherapie. Dennoch ist v. a. infolge der zunehmenden Antibiotikaresistenzen das Interesse für mögliche Ergänzungen der Therapie von großer Bedeutung für die zukünftige Unfallchirurgie und Orthopädie.

Methode

Vor dem Hintergrund eigener experimenteller bzw. klinischer Erfahrungen und auf der Basis der aktuellen Literatur wurden mögliche, zukünftig ggf. wichtige antiinfektiöse Strategien erarbeitet.

Ergebnisse/Schlussfolgerungen

Bakteriophagen, vor ca. einem Jahrhundert entdeckt und klinisch verwendet, werden seit ca. einem Jahrzehnt auch im westeuropäischen Raum eingesetzt, derzeit v. a. bei Brandverletzten. Es ist vorstellbar, dass Phagenpräparate angesichts der zunehmenden Antibiotikamultiresistenz von hoher Bedeutung sein werden. Sie werden jedoch nicht zu einem reinen Ersatz für Antibiotika werden. Vielmehr wird es zielführend sein, eine Kombination von Bakteriophagen und Antibiotika als interagierende Gesamttherapie einzusetzen. Ebenso nimmt die klinische Bedeutung antimikrobieller Peptide (AMPs) zu. Bislang wird vorwiegend experimentell am möglichen Einsatz von AMPs gearbeitet. Einzelne AMPs sind jedoch bereits in der Therapie etabliert (Colistin). Weitere diagnostische und therapeutische Maßnahmen werden sich durch den möglichen Einsatz der photodynamischen Therapie, der UV-Licht-Applikation und durch die differenzierte Analyse des Genoms sowie der individuellen Stoffwechsellage (Metabolom) von Erregerzelle und Patientengewebe ergeben.

Abstract

Background

The key elements in the therapy of surgical site infections (SSI) are surgical debridement and local and systemic antibiotic therapy; however, due to increasing antibiotic resistance, the development of additional therapeutic measures is of great interest for future trauma and orthopedic surgery.

Method

Against the background of our own experimental and clinical experiences and on the basis of the current literature, possible future anti-infective strategies were elaborated.

Results/conclusions

Bacteriophages were discovered and clinically implemented approximately one century ago and have been used in Western Europe for about one decade. They are currently used mainly in patients with burn injuries. It is likely that bacteriophages will become of great importance in view of the increasing antibiotic multi-drug resistance; however, they will probably not entirely replace antibiotic drugs. A combined use of bacteriophages and antibiotics is likely to be a more reasonable efficient therapy. In addition, the clinical importance of antimicrobial peptides (AMP) also increases. Up to now the possible use of AMPs is still experimental; however, individual AMPs are already established in the routine therapy (e. g. colistin). Further diagnostic and therapeutic measures may include photodynamic therapy, ultraviolet (UV) light application and differentiated genome analysis as well as the individual metabolism situation (metabolomics) of the pathogen cell and the patient tissue.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland

    D. Vogt &  C. Willy MD

  2. Klinik für Allgemein- und Viszeralchirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland

    S. Sperling

  3. Abteilung Septische Chirurgie, Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Deutschland

    T. Tkhilaishvili MD & A. Trampuz PD

  4. Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Brüssel, Belgien

    J.-P. Pirnay PhD, MSc.En

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  1. D. Vogt
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Correspondence to C. Willy MD.

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D. Vogt, S. Sperling, T. Tkhilaishvili, A. Trampuz, J.-P. Pirnay, und C. Willy geben an, dass kein Interessenkonflikt besteht.

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A. Trampuz, Berlin

C. Willy, Berlin

Die Autoren D. Vogt und S. Sperling teilen sich die Erstautorenschaft.

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Vogt, D., Sperling, S., Tkhilaishvili, T. et al. „Beyond antibiotic therapy“ – Zukünftige antiinfektiöse Strategien – Update 2017. Unfallchirurg 120, 573–584 (2017). https://doi.org/10.1007/s00113-017-0374-6

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