Division of Infectious Diseases, School of Medicine, Stanford University, Stanford, CA, USA.
Division of Infectious Diseases, Department of Medicine, Stanford University, 279 Campus Drive, Beckman Center, Room B237, Stanford, CA, 94305, USA.
Lung. 2024 Jun;202(3):223-232. doi: 10.1007/s00408-024-00700-7. Epub 2024 May 21.
We are entering the post-antibiotic era. Antimicrobial resistance (AMR) is a critical problem in chronic lung infections resulting in progressive respiratory failure and increased mortality. In the absence of emerging novel antibiotics to counter AMR infections, bacteriophages (phages), viruses that infect bacteria, have become a promising option for chronic respiratory infections. However, while personalized phage therapy is associated with improved outcomes in individual cases, clinical trials demonstrating treatment efficacy are lacking, limiting the therapeutic potential of this approach for respiratory infections. In this review, we address the current state of phage therapy for managing chronic respiratory diseases. We then discuss how phage therapy may address major microbiologic obstacles which hinder disease resolution of chronic lung infections with current antibiotic-based treatment practices. Finally, we highlight the challenges that must be addressed for successful phage therapy clinical trials. Through this discussion, we hope to expand on the potential of phages as an adjuvant therapy in chronic lung infections, as well as the microbiologic challenges that need to be addressed for phage therapy to expand beyond personalized salvage therapy.
我们正步入后抗生素时代。抗生素耐药性（AMR）是导致慢性肺部感染、进行性呼吸衰竭和死亡率增加的一个严重问题。在缺乏新型抗生素来对抗 AMR 感染的情况下，噬菌体（感染细菌的病毒）已成为治疗慢性呼吸道感染的一种有前途的选择。然而，尽管个性化噬菌体治疗与个别病例的改善结果相关，但缺乏临床疗效试验，限制了该方法在呼吸道感染方面的治疗潜力。在这篇综述中，我们探讨了噬菌体治疗在管理慢性呼吸道疾病方面的现状。然后，我们讨论了噬菌体治疗如何解决当前基于抗生素的治疗方法阻碍慢性肺部感染疾病治愈的主要微生物学障碍。最后，我们强调了成功进行噬菌体治疗临床试验必须解决的挑战。通过这次讨论，我们希望扩大噬菌体作为慢性肺部感染辅助治疗的潜力，以及为了使噬菌体治疗超越个性化抢救治疗而需要解决的微生物学挑战。
