Phage therapy in prosthetic joint infections caused by Staphylococcus aureus - A literature review

Area of Science:

• Infectious Diseases
• Microbiology
• Biotechnology

Background:

• Prosthetic joint infections (PJIs) are serious complications of arthroplasty, frequently caused by Staphylococcus aureus.
• Treatment challenges include antibiotic resistance (e.g., MRSA) and biofilm formation.
• Current gold-standard treatments like two-stage revision surgery or debridement, antibiotics, and implant retention (DAIR) have limitations.

Purpose of the Study:

• To comprehensively review the efficacy of bacteriophage therapy against Staphylococcus aureus in PJIs.
• To evaluate the safety and potential of phage therapy as an adjunct treatment for PJIs.

Main Methods:

• A literature review of 17 publications was conducted.
• Studies included in vitro experiments, animal models (mice, rats, rabbits, moth larvae), and human case reports.
• The review focused on phage efficacy against S. aureus, including MRSA and biofilms, and assessed safety profiles.

Main Results:

• Phages demonstrated effectiveness against diverse S. aureus strains, including MRSA and those in biofilms.
• In vivo studies confirmed favorable phage properties for PJI treatment, showing synergy with antibiotics.
• Human case reports indicated successful bacterial eradication with phage therapy, generally without major side effects, though elevated liver enzymes were occasionally noted.

Conclusions:

• Phage therapy presents promising evidence for safety and suitability as an adjuvant to DAIR for S. aureus PJIs.
• Further research is warranted to solidify the role of bacteriophages in PJI management.
• Bacteriophage therapy offers a potential novel strategy to combat challenging prosthetic joint infections.