D Vogt1, S Sperling2, T Tkhilaishvili3, A Trampuz3, J-P Pirnay4, C Willy5. 1. Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland. 2. Klinik für Allgemein- und Viszeralchirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland. 3. Abteilung Septische Chirurgie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Deutschland. 4. Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Brüssel, Belgien. 5. Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland. christianwilly@bundeswehr.org.
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.
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.
Authors: Guido W Van Oijen; Peter D Croughs; Tjebbe Hagenaars; Michael H J Verhofstad; Esther M M Van Lieshout Journal: J Bone Jt Infect Date: 2019-09-18
Authors: Jolien Onsea; Virginia Post; Tim Buchholz; Hella Schwegler; Stephan Zeiter; Jeroen Wagemans; Jean-Paul Pirnay; Maya Merabishvili; Matteo D'Este; Stijn G Rotman; Andrej Trampuz; Michael H J Verhofstad; William T Obremskey; Rob Lavigne; R Geoff Richards; T Fintan Moriarty; Willem-Jan Metsemakers Journal: Microbiol Spectr Date: 2021-12-15