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Rolle des Mikrobioms bei chronischen Wunden

Role of the microbiome in chronic wounds

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Zusammenfassung

Hintergrund

Das Mikrobiom als Gesamtheit mikrobieller Lebensformen in definierten Körperbereichen hat große Bedeutung in der Regulation wichtiger Funktionen des Makroorganismus.

Fragestellung

Welche Bedeutung hat das Wundmikrobiom für die Behandlung chronischer Wunden? Welche Wechselwirkungen bestehen zu anderen Mikrobiomen, und welche Schlussfolgerungen ergeben sich daraus für das Wundmanagement?

Material und Methoden

Abstriche oder Débridementproben aus Wunden werden kultur- bzw. genbasiert auf mikrobielle Erreger untersucht. Aus den genetischen Ergebnissen ergibt sich das Wundmikrobiom. Die Erreger werden nach Art und proportionalem Vorkommen bewertet und verschiedenen Faktoren wie Lokalisation und Art der Wunde, Erkrankung und Nebendiagnosen zugeordnet.

Ergebnisse

Im Wundmikrobiom finden sich erheblich mehr Keimspezies und -mengen im Vergleich zu konventionellen mikrobiologischen Nachweismethoden. Das Wundmikrobiom steht in direkter Beziehung zum Hautmikrobiom und zeigt eine komplexe und zu verschiedenen Untersuchungszeiten unterschiedliche Zusammensetzung, außerdem inter- und intraindividuelle Unterschiede. Bei Wunden von diabetischen Patienten zeigen sich krankheitsspezifische Veränderungen, z. B. dominieren Staphylokokkenspezies, bei Nichtdiabetikern dagegen Streptokokken.

Schlussfolgerungen

Die Analyse des Wundmikrobioms befindet sich im Anfangsstadium. Es zeigt sich bereits, dass es bei hämodynamischen Störungen krankheitsspezifische Beziehungen zum Wundmikrobiom gibt, die auch Hinweise auf den Verlauf geben können. Die aus dem Hautmikrobiom bekannten Phänomene mit Auswirkungen auf Pathogene dürften auch in der Wunde wirksam werden. Hier zeigen sich Wege moderner antiinfektiver Behandlungsoptionen wie der Besiedlungsmodulation jenseits der konventionellen antimikrobiellen Chemotherapie auf.

Abstract

Background

The microbiome, collective microbial life in defined areas of the body, is of great importance.

Objective

What is the significance of the wound microbiome in the treatment of chronic wounds? Which interactions exist with other microbiomes and which conclusions can be drawn for wound management?

Materials and methods

Swabs or debridement samples from wounds were analysed for microbial growth by culture or gene-based techniques. The genetic results are used to determine the wound microbiome. The pathogens were evaluated according to proportion of different species and related to different factors like type and location of wound, disease and underlying illnesses and to define the wound microbiome.

Results

In comparison with conventional microbiological detection methods the wound microbiome comprises many more types and quantities of species. The wound microbiome is related to skin microbiome showing complex and time-dependent composition, as well as inter- and intraindividual differences. Diabetic wounds exhibit disease-related changes, e.g. staphylococcal species dominate whereas streptococcal species dominate in nondiabetic wounds.

Conclusions

The analysis of wound microbiome is still at an early stage; however it has already been shown that in hemodynamic disorders there are disease-specific relationships with the wound microbiome, which can also provide clues about the course of the disease. Phenomena from the skin microbiome should also be effective in wounds. In this context modern antimicrobial treatment options beyond conventional chemotherapy like colonization modulation become possible.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hautkrankheiten, Universitätsmedizin Greifswald, Sauerbruchstr. 1–4, 17475, Greifswald, Deutschland

    Georg Daeschlein & Michael Jünger

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    Peter Hinz

  3. Rehabilitationszentrum für Innere Medizin, Rüdersdorf b. Berlin, Deutschland

    Thomas Kiefer

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Correspondence to Georg Daeschlein.

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G. Daeschlein, P. Hinz, T. Kiefer und M. Jünger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Daeschlein, G., Hinz, P., Kiefer, T. et al. Rolle des Mikrobioms bei chronischen Wunden. Hautarzt 70, 422–431 (2019). https://doi.org/10.1007/s00105-019-4425-5

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