Clarke Alex L, De Soir Steven, Jones Joshua D
Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Rue Bruyn, 1120 Brussels, Belgium.
Antibiotics (Basel). 2020 Nov 10;9(11):795. doi: 10.3390/antibiotics9110795.
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% ( = 258/277) achieved clinical resolution, 3.3% ( = 9/277) had improvement and 3.6% ( = 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.
细菌对抗生素的耐药性激发了人们对替代抗菌策略的兴趣。噬菌体是细菌病毒，具有成功用于治疗的悠久历史。噬菌体疗法是一种有前景的抗菌策略，可用于治疗包括顽固性骨与关节感染在内的具有生物膜成分的感染，这些感染会产生重大的社会、经济和人力影响。在此，我们报告了一项关于噬菌体疗法治疗骨与关节感染的安全性和有效性的系统评价。系统检索了三个电子数据库，以查找报告有关人类噬菌体疗法治疗骨与关节感染的原始数据的文章。两位作者独立评估研究的合格性并进行数据提取。17份报告符合纳入本评价的条件，代表了对277例患者的治疗。一个初步的、粗略的疗效估计显示，93.1%（=258/277）实现了临床缓解，3.3%（=9/277）有改善，3.6%（=10/277）无改善。直接评论噬菌体疗法安全性的9份报告中有7份未表达安全担忧。其余两份报告中报告的不良反应并不严重，与接受高滴度静脉噬菌体疗法治疗的一名患者中存在污染内毒素和既往肝脏病变有关。另外三份来自1940年至1987年的报告对噬菌体疗法的安全性进行了一般性评论，并记录了与使用原始噬菌体裂解物同时给予内毒素相关的不良反应。总之，本评价确定的报告表明，适当纯化的噬菌体是治疗复杂和顽固性骨与关节感染的一种安全且高效的治疗选择。
