Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK.
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
J Orthop Res. 2021 Feb;39(2):240-250. doi: 10.1002/jor.24683. Epub 2020 Apr 14.
Musculoskeletal infections (MSKIs) remain a major health burden in orthopaedics. Bacterial toxins are foundational to pathogenesis in MSKI, but poorly understood by the community of providers that care for patients with MSKI, inducing an international group of microbiologists, infectious diseases specialists, orthopaedic surgeons and biofilm scientists to review the literature in this field to identify key topics and compile the current knowledge on the role of toxins in MSKI, with the goal of illuminating potential impact on biofilm formation and dispersal as well as therapeutic strategies. The group concluded that further research is needed to maximize our understanding of the effect of toxins on MSKIs, including: (i) further research to identify the roles of bacterial toxins in MSKIs, (ii) establish the understanding of the importance of environmental and host factors and in vivo expression of toxins throughout the course of an infection, (iii) establish the principles of drug-ability of antitoxins as antimicrobial agents in MSKIs, (iv) have well-defined metrics of success for antitoxins as antiinfective drugs, (v) design a cocktail of antitoxins against specific pathogens to (a) inhibit biofilm formation and (b) inhibit toxin release. The applicability of antitoxins as potential antimicrobials in the era of rising antibiotic resistance could meet the needs of day-to-day clinicians.
肌肉骨骼感染（MSKI）仍然是骨科领域的一个主要健康负担。细菌毒素是 MSKI 发病机制的基础，但关心 MSKI 患者的医务人员对此了解甚少，这促使一组国际微生物学家、传染病专家、骨科医生和生物膜科学家审查该领域的文献，以确定关键主题，并汇编有关毒素在 MSKI 中的作用的现有知识，目的是阐明毒素对生物膜形成和分散以及治疗策略的潜在影响。该小组得出结论，需要进一步研究来最大程度地了解毒素对 MSKIs 的影响，包括：（i）进一步研究以确定细菌毒素在 MSKIs 中的作用，（ii）建立对环境和宿主因素以及毒素在整个感染过程中的体内表达的重要性的认识，（iii）确定抗毒素作为 MSKIs 中的抗微生物剂的药物可开发性原则，（iv）为抗毒素制定明确的成功标准作为抗感染药物，（v）设计针对特定病原体的抗毒素混合物，以（a）抑制生物膜形成和（b）抑制毒素释放。抗毒素作为抗生素耐药性日益严重时代的潜在抗菌药物的适用性可能满足日常临床医生的需求。
