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Die Unfallchirurgie
Erschienen in: Der Unfallchirurg 6/2017

24.05.2017 | Implantatassoziierte Infekte | Leitthema

Bedeutung des Biofilms für die Infektbehandlung in der Unfallchirurgie

Update 2017

verfasst von: C. Scheuermann-Poley, M.D., Prof. Dr. C. Wagner, M.D., J. Hoffmann, M. Sc., PD Dr. A. Moter, Prof. Dr. C. Willy, M.D.

Erschienen in: Die Unfallchirurgie | Ausgabe 6/2017

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Zusammenfassung

Einleitung

Mit Zunahme der endoprothetischen und osteosynthetischen Versorgung geht ein synchroner Anstieg der Anzahl implantatassoziierter Infekte („surgical site infections“, SSI) einher. Bei diesen Infekten und auch stark kontaminierten Defektwunden scheint das Entstehen von Biofilmen eine große Rolle für Diagnostik und Therapie zu spielen. Der vorliegende Artikel soll einen aktuellen Überblick über die Bedeutung von „Biofilm“ für die Unfallchirurgie geben.

Methodik

Computergestützte Literatursuche, durchgeführt mit MedLine(PubMed)-Suche. Schlüsselwörter Wortkombinationen mit „biofilm“ (Stand März 2017).

Ergebnisse

Biofilm, als polymikrobielle Organisations- und Lebensform eingebunden in eine protektive Polysaccharidmatrix, beschreibt die Anpassungsstrategie von Bakterien unter ungünstigen Lebensbedingungen (z. B. Antibiotikatherapie). In stark kontaminierten Defektwunden können nach 6 h Biofilme entstehen. Biofilme sollen in akuten und chronischen Infektsituationen in 30–80 % der Fälle vorkommen. In der routinemikrobiologischen Untersuchung sind planktonische (metabolisch aktive, kultivierbare) Bakterien, nicht jedoch Biofilme darstellbar. Molekularmikroskopische Methoden, wie die Fluoreszenz in situ Hybridisierung (FISH), ermöglichen den Nachweis von Bakterien im Biofilm. Kerne der anti-Biofilm-Therapie sind die Prävention von Biofilmen und die frühzeitige chirurgische Therapie mit Débridement, ergänzt durch die lokale und/oder systemische Applikation von Antibiotika sowie die lokale Anwendung von Antiseptika.

Schlussfolgerung

In stark kontaminierten Wunden und akuten sowie chronischen Infektsituationen muss mit der Entstehung von Biofilm gerechnet werden. Die beste Strategie zur Bekämpfung von Biofilmen ist die Prävention seiner Entstehung. Mit der herkömmlichen routinemikrobiologischen Nachweismethode gelingt kein Nachweis von Biofilm. Daher ist das Implementieren molekularbiologischer Nachweismethoden (z. B. FISH) wichtig. An weiteren anti-Biofilm-Strategien wird experimentell gearbeitet, jedoch liegen noch keine Möglichkeiten der klinischen Nutzung vor.
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Metadaten
Titel
Bedeutung des Biofilms für die Infektbehandlung in der Unfallchirurgie
Update 2017
verfasst von
C. Scheuermann-Poley, M.D.
Prof. Dr. C. Wagner, M.D.
J. Hoffmann, M. Sc.
PD Dr. A. Moter
Prof. Dr. C. Willy, M.D.
Publikationsdatum
24.05.2017
Verlag
Springer Medizin
Erschienen in
Die Unfallchirurgie / Ausgabe 6/2017
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-017-0361-y

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