This chapter provides a general definition of what wounds are and describes specific wound infections that have been investigated for their receptiveness to phage therapy. It highlights some of the early clinical work, from the pre-antibiotic era, when phage therapy was first used to prevent and treat wound infections, as well as other localized infections. It also provides insights into some of the reasons for failure of these approaches as judged by today's standards. Finally, this chapter discusses the strengths and weaknesses in experimental design of various animal models used to determine the efficacy of bacteriophages as antimicrobials.

Western scientists have steadily been gaining interest in phage therapy since the mid-1980's due to the rising problem of antibiotic resistance. Its introduction in the 20 th century by Felix d'Herelle marked the beginning for the uses of bacteriophages as antibacterial agents. However, a lack in understanding phage biology, as well as the arrival of broad-spectrum antibiotics deprioritized using phage therapy to treat bacterial infections in the West. With the advent of molecular biology, we are now better able to understand the predator-prey relationships with which phage co-evolve with their hosts as well as the specificity of phage-host interactions which could lend itself into personalized treatments for infection. These discoveries give us greater insights on how to most effectively use bacteriophage as potential therapeutic agents. It is encouraging to note that bacteriophages are used as food additives in the U.S., suggesting that the FDA acknowledges the positive potential of bacteriophages for human applications. Unfortunately, there are only a few examples to date of bacteriophages used on humans in controlled clinical trials. Rigorous studies in-vitro and especially in-vivo are critically important to avoid the mishaps of our predecessors.Phage biologists must strive to meet regulatory standards and to design thorough, rugged studies in order to establish a substantiated need for phage therapy in health care.

Staphylococcus aureus causes the majority of implant-related infections. These infections present as biofilms, in which bacteria adhere to the surface of foreign materials and form robust communities that are resilient to the human immune system and antibiotic drugs. The heavy use of broad-spectrum antibiotics against these pathogens disturbs the host’s microbiome and contributes to the growing problem of antibiotic-resistant infections. The use of bacteriophages as antibacterial agents is a potential alternative therapy. In this study, bioluminescent strains of S. aureus were grown to form 48-h biofilms on polyether ether ketone (PEEK), a material used to manufacture orthopaedic implants, in either static or dynamic growth conditions. Biofilms were treated with vancomycin, staphylococcal phage, or a combination of the two. We showed that vancomycin and staph phages were able to independently reduce the total bacterial load. Most phage-antibiotic combinations produced greater log reductions in surviving bacteria compared to single-agent treatments, suggesting antimicrobial synergism. In addition to demonstrating the efficacy of combining vancomycin and staph phage, our results demonstrate the importance of growth conditions in phage-antibiotic combination studies. Dynamic biofilms were found to have a substantial impact on apparent treatment efficacy, as they were more resilient to combination treatments than static biofilms.