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Bacteriophages (phages for short) are increasingly put forward as potential (additional) tools in the fight against the worldwide antibiotic crisis. However, the setup of clinical trials, which are necessary to demonstrate the efficacy of phages and to optimize their clinical application protocols, and consequently to their implementation in the clinic is still hindered by the lack of an adapted regulatory framework. Although some (local) progresses have been made in recent years, no real paradigm shift has occurred. This chapter discusses the current status in Europe with regard to the two most pertinent barriers to phage therapy: the regulatory and intellectual property protection issues.

The key elements in the therapy of surgical site infections (SSI) are surgical debridement and local and systemic antibiotic therapy; however, due to increasing antibiotic resistance, the development of additional therapeutic measures is of great interest for future trauma and orthopedic surgery.Against the background of our own experimental and clinical experiences and on the basis of the current literature, possible future anti-infective strategies were elaborated.Bacteriophages were discovered and clinically implemented approximately one century ago and have been used in Western Europe for about one decade. They are currently used mainly in patients with burn injuries. It is likely that bacteriophages will become of great importance in view of the increasing antibiotic multi-drug resistance; however, they will probably not entirely replace antibiotic drugs. A combined use of bacteriophages and antibiotics is likely to be a more reasonable efficient therapy. In addition, the clinical importance of antimicrobial peptides (AMP) also increases. Up to now the possible use of AMPs is still experimental; however, individual AMPs are already established in the routine therapy (e. g. colistin). Further diagnostic and therapeutic measures may include photodynamic therapy, ultraviolet (UV) light application and differentiated genome analysis as well as the individual metabolism situation (metabolomics) of the pathogen cell and the patient tissue.

International audience

D. De Vos1,∗, J.P. Santos2, F. Bilocq1, M. Oliveira3, R. Seixas3, A. Leitao4, P. Soentjens5, W. Heuninckx6, S. Jennes1, J.-P. Pirnay1 1 Queen Astrid Military Hospital, Brussels, Belgium 2 Universidade de lisboa, Lisbon, Portugal 3 Universidade de Lisboa, Lisbon, Portugal 4 Instituto de Investigacao Cientifica tropical CVZ,IICT;CIISA, Lisbon, Portugal 5 Centre for Infectious Diseases, Brussels, Belgium 6 Queen Astrid Military Hospital, Brussels, Benin

Background: Worldwide MRSA infections pose lifethreatening problems among critically ill and elderly. In Belgium the proportion of MRSA/MSSA is 23%, increasing to 35% on Intensive Care Units (ICU). Seen the consequences on morbidity, mortality and cost anti-nosocomial infection strategies are implemented. Collecting and analyzing those data is essential for evaluating and monitoring the situation. Methods: At admission all patients are systematically screened by nasal and peri-anal/or groin region. The swabs are cultured on Chapman medium and consecutively put on Vitek for antibiotic-susceptibility testing. During hospitalization a screening is done two times weekly. Results: From January 2002 till December 2007, 703 patients were admitted at our ICU and 1494 at our Medium Care Unit (MCU). Nasal swabs showed to be the best screening sampling procedure. The mean MRSA positive carriage at ICU admission is 1.5%. An increased trend was observed since 2004 (1 to 4%). At the MCU however a remarkably lower mean admission incidence of 0.5% was observed, with also the same trend for increase since 2004 (0.1 to 0.5). The nosocomially acquired MRSA infection rate is 5% on the ICU and 4% on the MCU. The higher incidence at the ICU admission is probably due to the fact that this patient population includes patients who are referred from another ICU, beside two other risk factors in this population, the age and often a marginal origin from a social-economic lower class. Conclusion: We observe a trend for increase the last 3 years which reflects the presence of MRSA in the community. This increase however is in contrast with the recently reported decrease of MRSA nosocomial infections in the global Belgian hospitalization population. Our nosocomial infection rate stayed at the same level and warrants an improved infection control in the future Reference: European Antibiotic Resistance Surveillance System (EARSS), 2004.