Widespread use and misuse of antibiotics have led to a dramatic increase in the emergence of antibiotic resistant bacteria, while the discovery and development of new antibiotics is declining. This has made certain implant-associated infections such as periprosthetic joint infections, where a biofilm is formed, very difficult to treat. Alternative treatment modalities are needed to treat these types of infections in the future. One candidate that has been used extensively in the past, is the use of ionizing radiation. This review aims to provide a historical overview and future perspective of radiation therapy in infectious diseases with a focus on orthopedic infections. A systematic search strategy was designed to select studies that used radiation as treatment for bacterial or fungal infections. A total of 216 potentially relevant full-text publications were independently reviewed, of which 182 focused on external radiation and 34 on internal radiation. Due to the large number of studies, several topics were chosen. The main advantages, disadvantages, limitations, and implications of radiation treatment for infections were discussed. In the pre-antibiotic era, high mortality rates were seen in different infections such as pneumonia, gas gangrene and otitis media. In some cases, external radiation therapy decreased the mortality significantly but long-term follow-up of the patients was often not performed so long term radiation effects, as well as potential increased risk of malignancies could not be investigated. Internal radiation using alpha and beta emitting radionuclides show great promise in treating fungal and bacterial infections when combined with selective targeting through antibodies, thus minimizing possible collateral damage to healthy tissue. The novel prospects of radiation treatment strategies against planktonic and biofilm-related microbial infections seem feasible and are worth investigating further. However, potential risks involving radiation treatment must be considered in each individual patient.

中文翻译：

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用电离辐射治疗感染：历史观点和新兴技术。

抗生素的广泛使用和滥用已导致抗生素抗性细菌的出现急剧增加，而新抗生素的发现和开发正在减少。这使得某些与植入物相关的感染（如假体周围关节感染）形成了生物膜，很难治疗。将来需要其他治疗方式来治疗这些类型的感染。过去已广泛使用的一种候选方法是使用电离辐射。这篇综述旨在提供传染病放射治疗的历史回顾和未来展望，重点是整形外科感染。设计了系统的搜索策略来选择使用放射线治疗细菌或真菌感染的研究。总共对216篇潜在相关的全文出版物进行了独立审查，其中182篇着重于外部辐射，而34篇着重于内部辐射。由于研究众多，因此选择了几个主题。讨论了放射治疗对感染的主要优点，缺点，局限性和意义。在抗生素时代之前，在不同的感染如肺炎，气性坏疽和中耳炎中观察到高死亡率。在某些情况下，外部放射疗法可显着降低死亡率，但通常不对患者进行长期随访，因此长期放射效应以及潜在的恶性肿瘤风险无法调查。当结合通过抗体的选择性靶向作用时，使用发射α和β的放射性核素的内部辐射在治疗真菌和细菌感染方面显示出广阔的前景，从而将对健康组织的潜在附带损害降至最低。对抗浮游生物和生物膜相关微生物感染的放射治疗策略的新前景看来是可行的，值得进一步研究。但是，每位患者都必须考虑涉及放射治疗的潜在风险。