The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review
Bacterial resistance to antibiotics has catalysed interest in alternative antimicrobial strategies. Bacteriophages (phages) are viruses of bacteria with a long history of successful therapeutic use. Phage therapy is a promising antibacterial strategy for infections with a biofilm component, includin...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-11-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/11/795 |
| _version_ | 1797548361401761792 |
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| author | Alex L. Clarke Steven De Soir Joshua D. Jones |
| author_facet | Alex L. Clarke Steven De Soir Joshua D. Jones |
| author_sort | Alex L. Clarke |
| collection | DOAJ |
| description | Bacterial resistance to antibiotics has catalysed interest in alternative antimicrobial strategies. Bacteriophages (phages) are viruses of bacteria with a long history of successful therapeutic use. Phage therapy is a promising antibacterial strategy for infections with a biofilm component, including recalcitrant bone and joint infections, which have significant social, financial and human impacts. Here, we report a systematic review of the safety and efficacy of phage therapy for the treatment of bone and joint infections. Three electronic databases were systematically searched for articles that reported primary data about human phage therapy for bone and joint infections. Two authors independently assessed study eligibility and performed data extraction. Seventeen reports were eligible for inclusion in this review, representing the treatment of 277 patients. A cautionary, crude, efficacy estimate revealed that 93.1% (<i>n</i> = 258/277) achieved clinical resolution, 3.3% (<i>n</i> = 9/277) had improvement and 3.6% (<i>n</i> = 10/277) showed no improvement. Seven of the nine reports that directly commented on the safety of phage therapy did not express safety concerns. The adverse effects reported in the remaining two were not severe and were linked to the presence of contaminating endotoxins and pre-existing liver pathology in a patient treated with high-titre intravenous phage therapy. Three other reports, from 1940–1987, offered general comments on the safety of phage therapy and documented adverse effects consistent with endotoxin co-administration concomitant with the use of raw phage lysates. Together, the reports identified by this review suggest that appropriately purified phages represent a safe and highly efficacious treatment option for complex and intractable bone and joint infections. |
| first_indexed | 2024-03-10T14:57:16Z |
| format | Article |
| id | doaj.art-d026d2eaea474fe1ad6efbccae0cfc85 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T14:57:16Z |
| publishDate | 2020-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-d026d2eaea474fe1ad6efbccae0cfc852023-11-20T20:28:51ZengMDPI AGAntibiotics2079-63822020-11-0191179510.3390/antibiotics9110795The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic ReviewAlex L. Clarke0Steven De Soir1Joshua D. Jones2Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UKLaboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Rue Bruyn, 1120 Brussels, BelgiumInfection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UKBacterial resistance to antibiotics has catalysed interest in alternative antimicrobial strategies. Bacteriophages (phages) are viruses of bacteria with a long history of successful therapeutic use. Phage therapy is a promising antibacterial strategy for infections with a biofilm component, including recalcitrant bone and joint infections, which have significant social, financial and human impacts. Here, we report a systematic review of the safety and efficacy of phage therapy for the treatment of bone and joint infections. Three electronic databases were systematically searched for articles that reported primary data about human phage therapy for bone and joint infections. Two authors independently assessed study eligibility and performed data extraction. Seventeen reports were eligible for inclusion in this review, representing the treatment of 277 patients. A cautionary, crude, efficacy estimate revealed that 93.1% (<i>n</i> = 258/277) achieved clinical resolution, 3.3% (<i>n</i> = 9/277) had improvement and 3.6% (<i>n</i> = 10/277) showed no improvement. Seven of the nine reports that directly commented on the safety of phage therapy did not express safety concerns. The adverse effects reported in the remaining two were not severe and were linked to the presence of contaminating endotoxins and pre-existing liver pathology in a patient treated with high-titre intravenous phage therapy. Three other reports, from 1940–1987, offered general comments on the safety of phage therapy and documented adverse effects consistent with endotoxin co-administration concomitant with the use of raw phage lysates. Together, the reports identified by this review suggest that appropriately purified phages represent a safe and highly efficacious treatment option for complex and intractable bone and joint infections.https://www.mdpi.com/2079-6382/9/11/795bone infectionosteomyelitisphage therapyprosthetic joint infectionsystematic review |
| spellingShingle | Alex L. Clarke Steven De Soir Joshua D. Jones The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review Antibiotics bone infection osteomyelitis phage therapy prosthetic joint infection systematic review |
| title | The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review |
| title_full | The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review |
| title_fullStr | The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review |
| title_full_unstemmed | The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review |
| title_short | The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review |
| title_sort | safety and efficacy of phage therapy for bone and joint infections a systematic review |
| topic | bone infection osteomyelitis phage therapy prosthetic joint infection systematic review |
| url | https://www.mdpi.com/2079-6382/9/11/795 |
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