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Vaccines against major ICU pathogens: where do we stand?

Pletz, Mathias W.; Uebele, Julia; Götz, Karen; Hagel, Stefan; Bekeredjian-Ding, Isabelle

Current Opinion in Critical Care: October 2016 - Volume 22 - Issue 5 - p 470–476
doi: 10.1097/MCC.0000000000000338
INFECTIOUS DISEASES: Edited by Tobias Welte

Purpose of review: Multidrug resistance of bacterial pathogens has confronted physicians around the world with the threat of inefficacy of the antibiotic regime, which is particularly important for patients with sepsis. Antibiotic resistance has revived search for alternative nonantibiotic strategies. Among them, prophylaxis by vaccination is an appealing concept.

Recent findings: This review provides a compact overview on available vaccines against community-acquired pathogens such as pneumococci (in synergy with influenza) and meningococci and provides an overview on the ongoing developments of vaccines targeting typical nosocomial pathogens such as Clostridium difficile, Staphylococcus aureus, Acintetobacter baumannii, Klebsiella pneumonia, and Pseudomonas aeruginosa.

Summary: The effects achieved by some conjugated vaccines (e.g. against Haemophilus influenzae B and Streptococcus pneumoniae) are encouraging. Their widespread use has resulted in a decrease or almost elimination of invasive diseases by the covered pneumococcal serotypes or Haemophilus influenzae B, respectively. These vaccines confer not only individual protection but also exploit herd protection effects. However, a multitude of failures reflects the obstacles on the way to effective and well tolerated bacterial vaccines. Regional differences in strain prevalence and variability of antigens that limit cross-protectivity remain major obstacles. However, promising candidates are in clinical development.

aCenter for Infectious Diseases and Infection Control, Jena University Hospital, Jena

bDivision of Microbiology, Paul-Ehrlich-Institut, Langen, Germany

Correspondence to Professor Mathias W. Pletz, MD, Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, Jena 07740, Germany. Tel: +49 3641 932 4650; e-mail: mathias.pletz@med.uni-jena.de

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