The promising role of bacteriophage therapy in managing total hip and knee arthroplasty related periprosthetic joint infection, a systematic review

Abstract

Purpose Total hip and knee arthroplasty periprosthetic joint infection (PJI) poses a management dilemma owing to the emergence of resistant organisms. A promising option is Bacteriophage therapy (BT) was used as an adjuvant for PJI management, aiming at treating resistant infections, decreasing morbidity, and mortality. The current review aimed to demonstrate the role and safety of using BT as an adjuvant to treat PJIs. Methods A systematic search was performed through four databases (Embase, PubMed, Web of Science, and Scopus) up to March 2022, according to the predetermined inclusion and exclusion criteria. Results Our systematic review included 11 case reports of 13 patients in which 14 joints (11 TKAs and three THAs) were treated. The patients’ average age was 73.7 years, underwent an average of 4.5 previous surgeries. The most common organism was the Staphylococcus aureus species. All patients underwent surgical debridement; for the 13 patients, eight received a cocktail, and five received monophage therapy. All patients received postoperative suppressive antibiotic therapy. After an average follow-up of 14.5 months, all patients had satisfactory outcomes. No recurrence of infection in any patient. Transaminitis complicating BT was developed in three patients, needed stoppage in only one, and the condition was reversible and non-life-threatening. Conclusion BT is a safe and potentially effective adjuvant therapy for treating resistant and relapsing PJIs. However, further investigations are needed to clarify some BT-related issues to create effective and reproducible therapeutics. Furthermore, new ethical regulations should be implemented to facilitate its widespread use.

The Medicinal Phage—Regulatory Roadmap for Phage Therapy under EU Pharmaceutical Legislation

“…So far, the European Medicines Agency (EMA) has only stated that some principles of the “Guideline on the evaluation of medicinal products indicated for treatment of bacterial infections” can also be applied to phages [ 7 ], after the EMA explicitly excluded this in the previous version of this guideline [ 8 ]. However, for about 15 years, successful individual cases have been documented and clinical studies have been conducted [ 4 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Osteoarticular prosthetic infection: how many patients are eligible for phage therapy? A French single-centre retrospective study

“…The therapeutic use of phage therapy in BJI has been noted in numerous publications [13,14] as yet without formal evidence of its e cacy [15]. Phage therapy represents a potentially new therapeutic treatment for BJI where the functional articular prognosis is severe and where therapeutic options are limited.…”

A Propensity Score Matched Exploration of Infection in Primary Total Ankle Arthroplasty

“…In total hip and total knee arthroplasty, a vast body of literature has outlined prosthetic joint infection (PJI) predictors, diagnostic criteria, and mitigation strategies. 1,3,6,20,23,24,27,28,34,35,39 In contrast, relatively little has been published regarding infection in TAA. 2 Infection has been identified as a catastrophic complication in TAA.…”