From October 3-7, 2018, IDWeek (Infectious Diseases Week) was held in San Francisco. It is the largest annual American scientific forum dedicated to infectious diseases and a platform for the exchange of experience, communication, and professional development of infectious disease specialists and epidemiologists from around the world. One of the IDWeek plenary sessions focused on phage therapy as a treatment for antibiotic-resistant infections.

One of the presentations was devoted to a clinical case that had been widely covered in the media: Dr. Steffanie Strathdee, an epidemiologist at the University of California, described how bacteriophages saved her husband's life. In 2015, he fell seriously ill due to a pancreatic infection caused by the bacterium Acinetobacter baumannii , which is resistant to all available antibiotics, including colistin. His condition worsened, and he developed septic shock and fell into a coma. Dr. Strathdee decided to try bacteriophage treatment. Her colleagues from various medical centers across the United States created a phage cocktail of four phage strains specific to Acinetobacter baumannii . The first dose of phages was administered directly into the abdominal abscess, and the next four were administered intravenously. Two days after the fourth infusion, the patient regained consciousness. Treatment was continued with other phage strains. As a result, the patient not only survived but also made a full recovery. This case prompted Dr. Strasdy and her colleague, Professor Robert T. Schooley, to open a medical center at the University of California, San Diego, to refine phage therapy methods and test new phage preparations— The Center for Innovative Phage Applications and Therapeutics (IPATH) . It is the first such center in North America.

"With antibiotic resistance looming globally and so few promising antibiotics in development, our own and other clinicians' successful experiences provide renewed impetus for the comprehensive evaluation of phage therapy in clinical trials," said Stephanie Strasdy.

"We're accumulating experience in this area, and now we need to move toward clinical trials," says Professor Skula. "This [phage therapy] is somewhat different from what the big pharma companies are producing—molecules active against as many targets as possible to treat as many patients as possible. This, on the contrary, is much more like personalized cancer therapy—it requires different approaches to development and a different commercialization paradigm."

Skuli and Strasdy are preparing a book for publication, entitled "The Ultimate Predator," in which they describe their own experiences with phage therapy and advocate for its widespread use.

Dr. Jonathan Iredell, an infectious disease physician at Westmead Hospital in Sydney and professor of medicine and microbiology at the University of Sydney (Australia), also spoke at the plenary session. He presented the results of using phage therapy in patients with life-threatening infections that were unresponsive to antibiotics. Phage therapy was performed using fixed phage cocktails against Staphylococcus aureus and Pseudomonas aeruginosa . Treatment was successful in 83% of cases.

Another interesting aspect of bacteriophage applications discussed at IDWeek was the development of phage lysins as antibacterial agents. Phage lysins are enzymes in bacteriophages that destroy the bacterial membrane when the phage particles are released into the environment. These enzymes can act as powerful antibacterial agents and are an alternative to antibiotics. Currently, one phage lysin-based drug that kills methicillin-resistant Staphylococcus aureus is undergoing Phase II clinical trials.

* Schooley RT, Biswas B, Gill JJ, Hernandez-Morales A et al. Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection // Antimicrob Agents Chemother, 2017, 61(10): e00954-17. doi: 10.1128/AAC.00954-17

** Fischetti VA. Development of Phage Lysins as Novel Therapeutics: A Historical Perspective // Viruses, 2018, 10(6). pii: E310. doi: 10.3390/v10060310.