Bacteriophage therapy for inhibition of multi drug-resistant uropathogenic bacteria: a narrative review

Abstract

Multi-Drug Resistant (MDR) uropathogenic bacteria have increased in number in recent years and the development of new treatment options for the corresponding infections has become a major challenge in the field of medicine. In this respect, recent studies have proposed bacteriophage (phage) therapy as a potential alternative against MDR Urinary Tract Infections (UTI) because the resistance mechanism of phages differs from that of antibiotics and few side effects have been reported for them. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis are the most common uropathogenic bacteria against which phage therapy has been used. Phages, in addition to lysing bacterial pathogens, can prevent the formation of biofilms. Besides, by inducing or producing polysaccharide depolymerase, phages can easily penetrate into deeper layers of the biofilm and degrade it. Notably, phage therapy has shown good results in inhibiting multiple-species biofilm and this may be an efficient weapon against catheter-associated UTI. However, the narrow range of hosts limits the use of phage therapy. Therefore, the use of phage cocktail and combination therapy can form a highly attractive strategy. However, despite the positive use of these treatments, various studies have reported phage-resistant strains, indicating that phage-host interactions are more complicated and need further research. Furthermore, these investigations are limited and further clinical trials are required to make this treatment widely available for human use. This review highlights phage therapy in the context of treating UTIs and the specific considerations for this application.

Keywords: Multi‐drug resistant; Phage therapy; Urinary tract infection; Urine.

Fig. 1

Catheter-associated urinary tract infections (UTI) and different aspects of bacteriophages therapy for inhibition and destruction of multiple-species biofilm. a The use of bacteriophages in combination therapies can increase the penetration of antibiotics into the deeper layers of the biofilm. b bacteriophages can control UTI by killing bacteria and inhibiting their virulence factors such as capsules. c The use of bacteriophage cocktails can be an effective to inhibit multiple-species biofilm in the UTI