Bacteriophages as a treatment for infections caused by multidrug-resistant bacteria hold great potential for patients who have suffered spinal cord injuries. This is discussed by doctors from the Balgrist Clinic at the University of Zurich (Switzerland) in an article published in the journal Spinal Cord.

Today, thanks to advances in medical care, rehabilitation methods, lifelong pharmacotherapy, and social support, patients who have suffered spinal cord injuries not only survive but can also participate in social and economic life. However, prolonged hospital stays for these patients increase their risk of developing hospital-acquired diseases, particularly hospital-acquired infections caused by multidrug-resistant bacteria. Respiratory and urinary tract infections, skin infections, and bone infections are the leading causes of death in patients with spinal cord injuries who survive the first year after injury.

The Western scientific literature has not yet described the use of phages in patients after spinal cord injury, but, according to the authors of the article,* bacteriophages have significant advantages for this cohort of patients.

Individuals with spinal cord injuries suffer from neurogenic dysfunction of the lower urinary tract. In many patients, this leads to recurrent urinary tract infections (UTIs), which are associated with high morbidity, mortality, and decreased quality of life.

The authors conducted in vitro experiments and found high lytic activity of commercially available phage preparations produced in Georgia against common UTI pathogens. The efficacy and safety of bladder instillation of bacteriophages in patients with UTIs who had undergone transurethral resection of the prostate was studied in a randomized clinical trial. However, this study did not include patients with spinal cord injury, who primarily suffer from catheter-associated infections. Therefore, the potential for phage therapy in this group will be explored in a trial scheduled to begin in the near future.

The authors also draw attention to phage therapy for respiratory tract infections. They point to important research in this area, in particular successful clinical cases of phage therapy for Pseudomonas aeruginosa infections in patients with cystic fibrosis and clinical trials in this area (clinicaltrials.gov: NCT04684641, NCT04596319). The existing experience does not directly apply to patients with spinal cord injury but provides valuable information on various methods of bacteriophage delivery, their effects on biofilms, and enhancing the interaction between bacteriophages and bacteria. It is also worth noting that the FDA has granted approval for the use of phages for the treatment of bacterial pneumonia resulting from complications in patients with COVID-19 (clinicaltrials.gov: NCT04636554).

The authors note another important problem for patients with spinal cord injuries: pressure ulcers, which are often aggravated by superinfection, which can lead to osteomyelitis. Successful phage therapy for osteomyelitis and artificial joint infections has already been described. Case reports describe surgical procedures used to apply the phage preparation directly to the site of infection. The use of phages in patients with osteomyelitis has also been described. Few cases of phage therapy for skin infections have been reported so far. According to the authors, the ability of phages to disrupt biofilms and kill bacteria offers significant potential for treating skin and bone infections in patients with spinal cord injuries. Clinical trials are now needed to evaluate the capabilities of phages in more detail: which phages should be used in which cases, at what concentration, how to administer, what courses of treatment, etc. The FDA recently granted orphan drug status to bacteriophages for the treatment of osteomyelitis and artificial joint infections, so clinical trials in this area are expected to begin very soon.

* Leitner L, McCallin S, Kessler TM. Bacteriophages: what role may they play in life after spinal cord injury? Spinal Cord. 2021 May 7;1-4. doi:10.1038/s41393-021-00636-2