Infectious complications after surgical interventions remain one of the most serious threats to patients. This is particularly true for chronically infected wounds , postoperative abscesses, and cases involving the formation of biofilms —dense colonies of bacteria that are virtually immune to antibiotics . Against this backdrop, the scientific community is once again turning its attention to bacteriophages—viruses that infect and destroy pathogenic microorganisms . Phage therapy in surgery is increasingly being viewed as a viable, effective alternative to traditional approaches.

Why Conventional Therapy Doesn't Always Work

With increasing antibiotic resistance, humanity is gradually losing one of its most important medical tools. This is especially dangerous in surgery, as surgical wound infections are often caused by bacteria resistant to multiple antibiotic groups, such as Pseudomonas aeruginosa , Staphylococcus aureus (including MRSA), and Acinetobacter baumannii .

In severe cases where antibiotics fail , doctors are forced to perform repeated surgeries, remove implants, or even amputate affected body parts. This is where phages come in, offering a chance to preserve tissue and avoid disability.

Phage therapy in surgery: mechanism and advantages

Bacteriophages are viruses that can detect specific bacterial cells, penetrate them, and destroy them from the inside. Due to their high specificity , phages attack only harmful microorganisms , leaving beneficial microflora or the patient's tissues unaffected.

In surgery, bacteriophages are used in the form of:

• local applications to wounds (gels, ointments, sprays);
• introduction through drains ;
• injections directly into the site of infection ;
• systemic use , when phages are administered intravenously.

This approach is especially effective when:

• chronic osteomyelitis;
• infected prostheses and meshes after hernioplasty;
• postoperative suppuration;
• complications after reconstructive surgery.

Successful examples from practice

Real-life clinical cases demonstrate the high efficacy of phage therapy in surgery . One of the most famous examples occurred in the United States in 2016. American Tom Patterson, while traveling in Egypt, became infected with a strain of Acinetobacter baumannii —an extremely resistant bacterium that caused severe sepsis and abdominal abscesses after surgical drainage of his pancreas. His condition rapidly deteriorated: no antibiotic worked , the infection spread, and the patient fell into a coma. As part of the compassionate use program, a team of UC San Diego physicians contacted several phage laboratories in the United States and Georgia to develop a personalized cocktail of bacteriophages. After administering phages directly to the infection sites through catheters and drainage systems, the patient began to recover. This case became the first successful example of phage therapy in a critically ill patient after surgery , documented in leading medical journals.

In 2020, a clinical trial was conducted in Poland involving 20 patients with chronic post-surgical wounds that had not been treated with standard antibiotics. Many of the patients had already developed biofilms on their wounds. Therapy included topical application of phage preparations tailored to each patient's specific bacteria. Complete wound debridement and healing were observed in 16 cases, without the need for repeat surgeries or amputations.

Georgia is a historical center for the development of phage therapy, particularly the Giorgi Eliava Institute in Tbilisi , which has been accumulating a database of phages against a wide range of bacteria since the 1920s. The Institute actively treats patients with complications following orthopedic, oncological, and general surgery . Patients from countries where phage therapy has not yet been approved at the state level, particularly Germany, Japan, the United States, and Canada, often seek treatment. For them, this is a chance to avoid repeat surgery or serious complications. Phages are often used after unsuccessful surgical interventions when antibiotics have failed to control the infection, especially in the presence of metal implants or endoprostheses.

Where else are phages used in surgical practice?

Besides Georgia, phage therapy is gradually being introduced into clinics:

• France , where clinical trials of phage-based drugs in postoperative therapy are being conducted;
• Belgium , which allows "phage therapy on demand";
• Poland , where phage therapy is being integrated into the classical healthcare system
• Israel , where phages are actively studied within the framework of regenerative medicine projects;
• India , where large-scale studies are conducted in hospitals during the treatment of soft tissue infections.

In the US and Canada, phages are not yet registered as drugs, but are approved for use in severe cases—through compassionate programs. Surgery is becoming the primary area of such use.

Phage therapy is just the beginning

Today, phage therapy in surgery is undergoing rapid development. Laboratories are opening, phage banks are being established, and new protocols for the combined use of bacteriophages and antibiotics are being developed. In the future, phages will likely become a common part of surgical kits, like antiseptics or dressings.

Furthermore, research is being conducted on integrating phages into biomaterials: for example, impregnating them into hernia mesh or implants, which can reduce the risk of infection immediately after surgery.

Phages are more than just a scientific curiosity. They are a modern alternative to antibiotics, already saving lives where traditional medicine fails. Their role in surgery is only growing, and the future appears to lie in personalized, highly specific methods of fighting infection .