Aktuelle Aspekte zur Pathogenese der Harnwegsinfektion

Zusammenfassung

Die Harnwegsinfektion zählt weiterhin zu den häufigsten bakteriellen Infektionen weltweit. Jede zweite Frau wird zumindest einmal in ihrem Leben eine Harnwegsinfektion erleiden. Bisher stellte die antimikrobielle Therapie eine kontrollierte und effektive Behandlung dar, doch könnte sich dies angesichts zunehmender multiresistenter Erreger und der stagnierenden Entwicklung neuer Antibiotika in nicht allzu ferner Zukunft ändern. Das Verständnis der komplexen Interaktion zwischen Harnwegserreger und Wirt im Rahmen einer Harnwegsinfektion ist daher in vielerlei Hinsicht von großem Interesse. Häufig beobachtete klinische Phänotypen weisen auf allgemeine Grundprinzipien hin, die für die Entwicklung neuer Therapieoptionen entscheidend sind. Durch die Ausbildung von intrazellulären Reservoiren gelingt es den Harnwegserregern nicht nur der ersten massiven Wirtsantwort im Harntrakt zu entgehen sondern auch langfristig eine Quelle für künftige Rezidive zu schaffen. Ein vielseitiges Repertoire an Virulenzfaktoren wird von hochspezialisierten Uropathogenen eingesetzt, um sich im Harntrakt etablieren zu können. Die Abwehrmechanismen des Wirtes dagegen scheinen auf wichtige Pathomechanismen speziell ausgerichtet zu sein. Erkenntnisse dieser vielschichtigen Interaktionen bieten die Gelegenheit, neue Therapieansätze zu entwickeln, die in Zukunft alternativ zu Antibiotika oder als Ergänzung zum Einsatz kommen könnten.

Abstract

Urinary tract infections are among the most common bacterial infectious diseases worldwide. Every second woman will experience at least one urinary tract infection in her lifetime. The administration of antibiotics has been a safe and efficient treatment modality so far. However, due to the emergence of multi-resistant pathogens and the developmental void of new antimicrobial drugs, the therapy of infections mighty become more challenging in the near future. So, knowledge of the complex host-pathogen interaction is of great importance. Common phenotypes observed in clinical practice suggest basic principles, which are relevant for the development of novel antimicrobial strategies. With invading pathogens forming intracellular bacterial communities they evade host response and provide a nidus for recurrent infection. A plethora of virulence factors allow uropathogenic bacteria to colonize and to establish infections in the urinary tract. In response, host responses seem to address specific virulence mechanisms that are essential to pathogenicity. Deciphering the molecular mechanisms underlying the complex host-pathogen interaction is critical to devise novel treatment options.

Schlüsselwörter

Harnwegsinfektion - Uropathogene Escherichia Coli (UPEC) - intrazelluläre Reservoire - Virulenzfaktoren

Key words

urinary tract infection - uropathogenic Escherichia coli (UPEC) - intracellular bacterial communities (IBC) - virulence factors

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