Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Department of Emergency Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Paediatr Respir Rev. 2023 Dec;48:3-9. doi: 10.1016/j.prrv.2023.08.001. Epub 2023 Aug 11.
Respiratory infections caused by Staphylococcus aureus and Pseudomonas aeruginosa are a major concern for cystic fibrosis (CF) patients due to increasing antibiotic resistance. Bacteriophages, which are viruses that selectively target and kill bacteria, are being studied as an alternative treatment for these infections. This systematic review evaluates the safety and effectiveness of bacteriophages for the treatment of CF-related infections caused by S. aureus and/or P. aeruginosa. We conducted a search for original, published articles in the English language up to March 2023. Studies that administered bacteriophages via intravenous, nebulised, inhaled, or intranasal routes were included, with no comparators required. In vitro and in vivo studies were eligible for inclusion, and only animal in vivo studies that utilised a CF transmembrane conductance regulator (CFTR) animal model were included. Bacteriophage treatment resulted in a decrease in bacterial load in both humans and animals infected with P. aeruginosa. Complete eradication of P. aeruginosa was only observed in one human subject. Additionally, there was a reduction in biofilm, improvement in resistance profile, and reduced pulmonary exacerbations in individual case reports. Evidence suggests that bacteriophage therapy may be a promising treatment option for CF-related infections caused by P. aeruginosa and S. aureus. However, larger and more robust trials are needed to establish its safety and efficacy and create necessary evidence for global legislative frameworks.
金黄色葡萄球菌和铜绿假单胞菌引起的呼吸道感染是囊性纤维化（CF）患者的主要关注点，因为这些细菌对抗生素的耐药性不断增加。噬菌体是一种选择性靶向和杀死细菌的病毒，目前正被研究作为治疗这些感染的替代方法。本系统评价评估了噬菌体治疗金黄色葡萄球菌和/或铜绿假单胞菌引起的 CF 相关感染的安全性和有效性。我们检索了截至 2023 年 3 月以英文发表的原始研究文章。纳入了通过静脉、雾化、吸入或鼻内途径给予噬菌体的研究，无需比较。符合条件的研究包括体外和体内研究，仅纳入了使用 CF 跨膜电导调节因子（CFTR）动物模型的动物体内研究。噬菌体治疗可降低感染铜绿假单胞菌的人和动物的细菌负荷。仅在一名人类受试者中观察到铜绿假单胞菌的完全清除。此外，在个别病例报告中，还观察到生物膜减少、耐药谱改善和肺部恶化减少。证据表明，噬菌体疗法可能是治疗 CF 相关的铜绿假单胞菌和金黄色葡萄球菌感染的有前途的治疗选择。然而，需要更大规模和更稳健的试验来确定其安全性和有效性，并为全球立法框架创建必要的证据。
