[Treatment of bone and periprosthetic infections with bacteriophages : A systematic review].

Background: The treatment of bone and prosthesis infections remains difficult despite modern treatment concepts. Further tools for the improvement of treatment outcome are desirable. Preclinical studies provide promising evidence of the efficacy of bacteriophages for the treatment of bone and joint infections.

Objectives: The present work provides a systematic review of the clinical application of bacteriophages for the treatment of bone and joint infections.

Materials and methods: A systematic search was performed in PubMed to identify primary clinical data on the use of phage therapy in patients with bone and joint infection.

Results: Eight case reports and three case series were included in the study. Indications for phage therapy were periprosthetic joint infection (n = 12, 52.2%), fracture-related infection (n = 9, 39.1%), osteomyelitis (n = 1, 4.4%) and sacroiliac joint infection after cement augmentation of a metastasis (n = 1, 4.4%). Interventions were heterogeneous; phages were administered intravenously, injected intraoperatively into the joint, applied locally intraoperatively, or administered via drains. In combination with antibiotic therapy, complete infection eradication was achieved in 18 patients (78.3%). No side effects were reported in 91.3% of patients.

Conclusion: Bacteriophages represent a promising treatment option for bone and prosthesis infections in combination with antibiotic therapy. Future clinical trials with a higher level of evidence are required for the successful translation of bacteriophage therapy into clinical practice.