Scheuermann-Poley C, Wagner C, Hoffmann J, Moter A, Willy C
Abteilung für Unfallchirurgie, Orthopädie, septische und plastische Chirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland.
Zentrum für Orthopädie und Unfallchirurgie, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Deutschland.
Unfallchirurg. 2017 Jun;120(6):461-471. doi: 10.1007/s00113-017-0361-y.
The increase in endoprosthetic and osteosynthetic surgical treatment is associated with a simultaneous increase in implant-associated infections (surgical site infections, SSI). Biofilms appear to play a significant role in the diagnosis and treatment of these infections and heavily contaminated wounds. This article aims to provide a current overview of biofilm and its relevance in orthopedic surgery.
A computer-assisted literature search of MedLine (PubMed) was performed using key word combinations with "biofilm" (as of March 2017).
Biofilm, a polymicrobial organization and life form surrounded by a polysaccharide matrix, refers to an adaptation strategy of bacteria in unfavorable living conditions (e. g. under antibiotic therapy). Biofilms can develop after 6 h in highly contaminated wounds. In acute and chronic infections, biofilms can occur in 30-80 % of the cases. Only planktonic bacteria (high metabolic activity, cultivable) can be detected in standard microbiological cultures, biofilms, however, cannot. Molecular microscopic methods, such as fluorescence in situ hybridization (FISH), enable the detection of bacteria in biofilms. The core concepts of anti-biofilm therapy include the prevention of biofilm and early surgical debridement, followed by the local and/or systemic administration of antibiotics as well as the local application of antiseptics.
The development of biofilm should be anticipated in strongly contaminated wounds as well as in acute and chronic infection sites. The best strategy to combat biofilms is to prevent their development. Standard microbiological culture methods do not enable the detection of biofilm. Therefore, the implementation of molecular biological detection methods (z. B. FISH) is important. Further anti-biofilm strategies are being investigated experimentally, but there are no real options for clinical use as of yet.
内置假体及骨合成手术治疗的增加与植入物相关感染（手术部位感染，SSI）的同时增加有关。生物膜似乎在这些感染和严重污染伤口的诊断及治疗中起着重要作用。本文旨在提供生物膜及其在骨科手术中的相关性的当前概述。
使用与“生物膜”相关的关键词组合，对MedLine（PubMed）进行计算机辅助文献检索（截至2017年3月）。
生物膜是一种被多糖基质包围的多微生物组织和生命形式，是细菌在不利生存条件下（如抗生素治疗期间）的一种适应策略。在高度污染的伤口中，6小时后即可形成生物膜。在急性和慢性感染中，30%-80%的病例会出现生物膜。标准微生物培养只能检测到浮游细菌（高代谢活性，可培养），而无法检测到生物膜。分子显微镜方法，如荧光原位杂交（FISH），能够检测生物膜中的细菌。抗生物膜治疗的核心概念包括预防生物膜形成和早期手术清创，随后局部和/或全身应用抗生素以及局部应用防腐剂。
在严重污染的伤口以及急性和慢性感染部位应预见到生物膜的形成。对抗生物膜的最佳策略是预防其形成。标准微生物培养方法无法检测到生物膜。因此，实施分子生物学检测方法（如FISH）很重要。目前正在对进一步的抗生物膜策略进行实验研究，但尚无真正可供临床使用的选择。
