Vogt D, Sperling S, Tkhilaishvili T, Trampuz A, Pirnay J-P, Willy C
Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland.
Klinik für Allgemein- und Viszeralchirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland.
Unfallchirurg. 2017 Jul;120(7):573-584. doi: 10.1007/s00113-017-0374-6.
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.
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.
手术部位感染（SSI）治疗的关键要素是手术清创以及局部和全身抗生素治疗；然而，由于抗生素耐药性不断增加，开发额外的治疗措施对未来创伤和骨科手术具有重大意义。
基于我们自身的实验和临床经验，并依据当前文献，阐述了未来可能的抗感染策略。
结果/结论：噬菌体大约在一个世纪前被发现并应用于临床，在西欧已使用了约十年。目前主要用于烧伤患者。鉴于抗生素多重耐药性不断增加，噬菌体可能会变得极为重要；然而，它们可能不会完全取代抗生素药物。噬菌体与抗生素联合使用可能是一种更合理有效的治疗方法。此外，抗菌肽（AMP）的临床重要性也在增加。到目前为止，AMP的可能用途仍处于实验阶段；然而，个别AMP已在常规治疗中确立（例如多粘菌素）。进一步的诊断和治疗措施可能包括光动力疗法、紫外线照射、差异化基因组分析以及病原体细胞和患者组织的个体代谢情况（代谢组学）。
