Bacteriophage therapy in musculoskeletal infections: from basic science to clinical application

Area of Science:

• Microbiology
• Infectious Diseases
• Biotechnology

Background:

• Musculoskeletal infections (MSIs), including periprosthetic joint infection (PJI) and fracture-related infection (FRI), are difficult to treat due to biofilms and rising antimicrobial resistance (AMR).
• Current treatments often require multiple surgeries and significant healthcare costs, highlighting the need for innovative therapeutic strategies.
• The World Health Organization recommends exploring non-traditional treatments like bacteriophage (phage) therapy for infections.

Purpose of the Study:

• To review the current status and future perspectives of bacteriophage therapy for musculoskeletal infections.
• To highlight the potential of phage therapy as an alternative or adjunct treatment for challenging MSIs.
• To identify challenges and propose solutions for the clinical implementation of phage therapy.

Main Methods:

• Review of historical clinical trials and recent case studies on phage therapy for MSIs.
• Analysis of current challenges in phage therapy, including study design, administration, and phage selection.
• Discussion of strategies to enhance treatment efficacy, such as personalized therapy and antibiotic combinations.

Main Results:

• Phage therapy, using lytic phages, shows potential for treating MSIs, with historical and recent studies demonstrating milestones.
• Challenges remain, including variability in study designs, administration methods, and phage selection criteria.
• Personalized phage therapy and combination with antibiotics are being explored to improve treatment outcomes.

Conclusions:

• Phage therapy is a promising strategy for combating antibiotic-resistant musculoskeletal infections.
• Addressing regulatory hurdles, standardizing protocols, and conducting robust clinical trials are crucial for advancing phage therapy.
• Initiatives like PHAGEFORCE and PHAGEinLYON are paving the way for personalized phage therapy and systematic data collection in MSIs.