Authors

    Language

    English

    Publication Date

    12-12-2024

    Journal

    EcoSal Plus

    DOI

    10.1128/ecosalplus.esp-0029-2023

    PMID

    39665540

    PMCID

    PMC11636367

    PubMedCentral® Posted Date

    1-11-2024

    PubMedCentral® Full Text Version

    Post-print

    Abstract

    In the face of rising antimicrobial resistance, bacteriophage therapy, also known as phage therapy, is seeing a resurgence as a potential treatment for bacterial infections including urinary tract infection (UTI). Primarily caused by uropathogenic Escherichia coli, the 400 million UTI cases annually are major global healthcare burdens and a primary cause of antibiotic prescriptions in the outpatient setting. Phage therapy has several potential advantages over antibiotics including the ability to disrupt bacterial biofilms and synergize with antimicrobial treatments with minimal side effects or impacts on the microbiota. Phage therapy for UTI treatment has shown generally favorable results in recent animal models and human case reports. Ongoing clinical trials seek to understand the efficacy of phage therapy in individuals with asymptomatic bacteriuria and uncomplicated cystitis. A possible challenge for phage therapy is the development of phage resistance in bacteria during treatment. While resistance frequently develops in vitro and in vivo, resistance can come with negative consequences for the bacteria, leaving them susceptible to antibiotics and other environmental conditions and reducing their overall virulence. “Steering” bacteria toward phage resistance outcomes that leave them less fit or virulent is especially useful in the context of UTI where poorly adherent or slow-growing bacteria are likely to be flushed from the system. In this article, we describe the history of phage therapy in treating UTI and its current resurgence, the state of its clinical use, and an outlook on how well-designed phage therapy could be used to “steer” bacteria toward less virulent and antimicrobial-susceptible states.

    Keywords

    Phage Therapy, Urinary Tract Infections, Humans, Animals, Uropathogenic Escherichia coli, Bacteriophages, Anti-Bacterial Agents, Escherichia coli Infections, Biofilms, Drug Resistance, Bacterial, phage therapy, urinary tract infection, bacteriophage resistance, uropathogenic E. coli, antimicrobial resistance

    Published Open-Access

    yes

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