Zusammenfassung
Der Einsatz implantierbarer Fremdmaterialien ist heute integraler Bestandteil der modernen Medizin. Diese Fremdmaterialien werden genutzt, um temporär oder längerfristig Organfunktionen zu unterstützen oder sogar, wie zum Beispiel beim Einsatz künstlicher Gelenke, vollständig zu ersetzen. Die Implantation von Fremdmaterialien stellt ein signifikantes Risiko für die Entwicklung einer Infektion dar: alleine in Deutschland werden jährlich bis zu 100.000 Fälle einer Infektion nach Fremdmaterialanwendung beobachtet. Bei diesen so genannten Fremdmaterial‐assoziierten Infektionen lässt sich in der überwiegenden Zahl von Fällen Staphylococcus epidermidis nachweisen. Dieser Erreger wird der Gruppe der Koagulase‐negativen Staphylokokken zugerechnet und kann regulär auf der Haut praktischer aller Menschen gefunden werden ohne hierbei eine pathogene Bedeutung zu haben. Demnach ist S. epidermidis im Kontext Implantatassoziierter Infektionen als ein klassischer opportunistischer Erreger zu bezeichnen. Sein selektives pathogenes Potential resultiert aus der Fähigkeit, die Oberfläche von künstlichen Materialien in Form fest haftender, mehrschichtiger Bakterienaggregate zu besiedeln. Diese Eigenschaft, die auch als Biofilmbildung bezeichnet wird, hat schwerwiegende Konsequenzen, denn sie schützt den Erreger vor dem Immunsystem des Menschen und macht ihn unempfindlich gegen Antibiotika. In der Folge imponieren S. epidermidis Infektionen als chronische, schwer behandelbare Erkrankungen, die in der Regel nur durch die Entfernung des Fremdmaterials geheilt werden können. Die Erforschung der genauen molekularen Zusammenhänge, die zur S. epidermidis Biofilmbildung führen, hat gezeigt, dass dieser Prozess von vielen unterschiedlichen Determinanten abhängt. Besonders bedeutsam sind bakterielle Oberflächenstrukturen wie Polysaccharide und Proteine, die die Wechselwirkung von S. epidermidis mit der Implantatoberfläche ermöglichen und durch die Ausbildung einer extrazellulären Matrix den Biofilm stabilisieren. Die differenzierten molekularen Erkenntnisse zur Entstehung von S. epidermidis Biofilmen haben bereits jetzt zur Formulierung und konkreten Untersuchung neuer Präventivmaßnahmen zur Vermeidung und therapeutischen Interventionen zur Behandlung implantatassoziierter Infektionen geführt. Die weitere Erforschung der molekularen Pathogenese von S. epidermidis Biofilminfektionen kann somit zukünftig zur Entwicklung neuartiger Behandlungsmethoden führen.
Abstract
Infections associated with indwelling medical devices are a major problem in modern medicine, affecting millions of patients worldwide each year. Coagulase‐negative Staphylococci, especially Staphylococcus epidermidis, are the most characteristic causative organisms isolated in the context of device‐related infections. The tight pathogenetic association between foreignbody implantation and staphylococcal infection is related to their capability to establish multilayered, highly structured biofilms on artificial surfaces. The ever‐increasing spread of highly resistant Staphylococci as well as the inherent resistance of biofilm‐organized bacteria against antibiotics and effector mechanisms of the host immune system regularly results in failure of conventional therapeutic protocols. In order to identify novel, innovative targets for improved diagnostic, therapeutic and prophylactic approaches the elucidation of the molecular pathogenesis of staphylococcal foreign‐body related infections has gained superior interest over the last two decades. This review summarizes the current knowledge of staphylococcal biofilm infections and emphasizes the implications of the progress made for clinical management.
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Rohde, H. (2014). Freund und Feind: Hautbakterien als Erreger von Krankenhausinfektionen. In: Fischer, M. (eds) Neue und alte Infektionskrankheiten. Springer Spektrum, Wiesbaden. https://doi.org/10.1007/978-3-658-04124-3_4
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