The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review.
The Safety and Efficacy of Phage Therapy for Bone and Joint Infections: A Systematic Review.
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DOI：
10.3390/antibiotics9110795
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发表时间：
2020-11-10
期刊：
影响因子：
--
通讯作者：
Jones JD
中科院分区：
文献类型：
--
作者：
Clarke AL;De Soir S;Jones JD
细菌对抗生素的耐药性激发了人们对替代抗菌策略的兴趣。噬菌体（噬菌体）是细菌病毒，具有悠久的成功治疗用途历史。噬菌体疗法是一种很有前途的抗菌策略，用于治疗生物膜成分的感染，包括顽固性骨和关节感染，其具有重大的社会、经济和人类影响。在这里，我们报告了对噬菌体疗法治疗骨和关节感染的安全性和有效性的系统评价。系统地搜索了三个电子数据库，寻找报告人类噬菌体治疗骨和关节感染的主要数据的文章。两位作者独立评估研究资格并进行数据提取。 17 份报告有资格纳入本次审查，代表 277 名患者的治疗情况。一项谨慎、粗略的疗效估计显示，93.1% (n = 258/277) 的患者获得了临床缓解，3.3% (n = 9/277) 的患者有所改善，3.6% (n = 10/277) 的患者没有任何改善。直接评论噬菌体疗法安全性的九份报告中有七份没有表达安全性担忧。其余两项报告的不良反应并不严重，与接受高滴度静脉内噬菌体疗法治疗的患者中污染性内毒素的存在和预先存在的肝脏病理有关。 1940 年至 1987 年的另外三份报告对噬菌体治疗的安全性进行了一般性评论，并记录了与内毒素联合给药和使用原始噬菌体裂解物相一致的不良反应。总之，本次审查确定的报告表明，适当纯化的噬菌体代表了复杂且棘手的骨和关节感染的安全且高效的治疗选择。
Bacterial resistance to antibiotics has catalysed interest in alternative antimicrobial strategies. Bacteriophages (phages) are viruses of bacteria with a long history of successful therapeutic use. Phage therapy is a promising antibacterial strategy for infections with a biofilm component, including recalcitrant bone and joint infections, which have significant social, financial and human impacts. Here, we report a systematic review of the safety and efficacy of phage therapy for the treatment of bone and joint infections. Three electronic databases were systematically searched for articles that reported primary data about human phage therapy for bone and joint infections. Two authors independently assessed study eligibility and performed data extraction. Seventeen reports were eligible for inclusion in this review, representing the treatment of 277 patients. A cautionary, crude, efficacy estimate revealed that 93.1% (n = 258/277) achieved clinical resolution, 3.3% (n = 9/277) had improvement and 3.6% (n = 10/277) showed no improvement. Seven of the nine reports that directly commented on the safety of phage therapy did not express safety concerns. The adverse effects reported in the remaining two were not severe and were linked to the presence of contaminating endotoxins and pre-existing liver pathology in a patient treated with high-titre intravenous phage therapy. Three other reports, from 1940–1987, offered general comments on the safety of phage therapy and documented adverse effects consistent with endotoxin co-administration concomitant with the use of raw phage lysates. Together, the reports identified by this review suggest that appropriately purified phages represent a safe and highly efficacious treatment option for complex and intractable bone and joint infections.
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