Bakteriophagen in der Gefäßchirurgie – ein alternativer kurativer Therapieansatz bei Graft-Infektionen

Zusammenfassung

Infektionen alloplastischer Gefäßprothesen sind schwerwiegende Komplikationen in der Gefäßchirurgie, die mit einer hohen Morbidität und Mortalität einhergehen. Die von den Leitlinien empfohlene Best-Practice-Therapie besteht in der Explantation infizierten Prothesenmaterials mit konsekutiver autologer Rekonstruktion. Hierbei handelt es sich jedoch um komplexe Revisionsoperationen mit hohem perioperativem Risiko, das insbesondere bei schweren Komorbiditäten oft nicht vertretbar erscheint. Zusätzlich wird die konservative antibiotische Therapie durch das zunehmende Auftreten von Antibiotikaresistenzen und die schwierig zu behandelnde Biofilmbildung an alloplastischem Gefäßersatzmaterial erschwert.
Bakteriophagen sind Viren, die selektiv Bakterien befallen und abtöten können. Sie stellen daher eine vielversprechende alternative antiinfektive Therapieoption dar. Obwohl das therapeutische Potenzial der Bakteriophagen bereits seit Beginn des 20. Jahrhunderts bekannt ist, existieren in der westlichen Medizin bis heute nur wenige klinische Studien zur Behandlung von Infektionen mit Bakteriophagen.
Die vorliegende Übersichtsarbeit fasst Biologie, Geschichte sowie Herausforderungen der Phagentherapie zusammen und zeigt anhand von 9 in Einzelfallberichten und kleineren Fallserien publizierten Patient*innen, wie Bakteriophagen in der Therapie von Gefäßprotheseninfektionen eingesetzt werden können, um komplikative resezierende Eingriffe zu vermeiden.

Abstract

Vascular graft infections pose as severe complications in vascular surgery and are linked to high morbidity and mortality. Guidelines recommend resection of infected grafts and concomitant autologous reconstruction, though redo-surgery might not always be reasonable in high-risk patients with significant comorbidities. Additionally, conservative antibiotic treatment is hindered by increasing antibiotic resistance rates and biofilm formation.
Bacteriophages are viruses that selectively infect and eradicate bacteria and are therefore a promising anti-infective therapeutic strategy. Though the therapeutic potential of bacteriophages has been known since the early 20th century, in western medicine only a few clinical studies on bacteriophage treatment in infectious diseases exist to date.
This review aims to outline history, biology and challenges of bacteriophage therapy. It summarizes 9 cases published in literature as case reports or small case series in which the treatment of vascular graft infections with bacteriophages is used to circumvent high-risk graft explantation surgery.

Schlüsselwörter

Bakteriophagen - Infektion - Gefäßprothesen - Gefäßchirurgie - biologische Therapie

Keywords

bacteriophages - infection - vascular graft - vascular surgery

Publication History

Received: 28 April 2025

Accepted after revision: 08 December 2025

Article published online:
23 January 2026

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