Susceptibilities of Multidrug-Resistant Pathogens Responsible for Complicated Skin and Soft Tissue Infections to Standard Bacteriophage Cocktails

Abstract

Skin and soft tissue infections (SSTIs) may represent a wide clinical spectrum from cellulitis to high-mortality associated necrotizing fasciitis. Limitations in therapy due to the multiple drug resistance, leads to increase in the morbidity and mortality rates, especially in complicated SSTIs such as diabetic foot, decubitus, and surgical wound infections. Therefore, alternative treatment strategies other than antibiotics are needed in appropriate clinical conditions. "Bacteriophage therapy", which is an old method and has been used as part of standard treatment in some countries such as Georgia and Russia, has again become popular worldwide. The aim of this study was to investigate the in vitro susceptibilities of multidrug-resistant (MDR) pathogens isolated from patients with complicated SSTIs, against standard bacteriophage (phage) cocktails. Six different ready-made phage preparations [Pyophage, Intestiphage, ENKO, SES, Fersisi and Staphylococcal Bacteriophage (Sb)] used in this study have been provided by G. Eliava Institute, Georgia. Because of the absence of ready-made phage preparations for Acinetobacter baumannii and Klebsiella pneumoniae, Φ1-Φ7 and ΦKL1- ΦKL3 phages were used provided from the same institute's phage library, respectively. Isolation and identification of the pathogens from abscess and wound samples of patients with SSTIs were performed by conventional methods and automatized VITEK(®)-2 (bioMerieux, ABD) system. Antimicrobial susceptibility testing was conducted complying CLSI standards' and the bacteria that were resistant to at least two different antibiotic groups were considered as MDR. Accordingly, a total of 33 isolates, nine of them were E.coli (8 ESBL and 1 ESBL + carbapenemase positive); nine were MDR P.aeruginosa; nine were MDR A.baumannii; three were methicillin-resistant Staphylococcus aureus (MRSA) and three were K.pneumoniae (1 ESBL, 1 carbapenemase and 1 ESBL + carbapenemase positive) were included in the study. The phage susceptibilities of the pathogens were performed by using spot test. In the study, 29 (87.9%) out of 33 MDR pathogens were found to be susceptible to at least one of the tested phage/phage preparations. All MRSA (3/3) strains were susceptible to ENKO, SES, Fersisi and Sb phage cocktails, while all A.baumannii isolates (9/9) were susceptible to Φ5 and Φ7 phages. However, two E.coli, one K. pneumoniae and one P.aeruginosa strains were resistant to the all phage preparations tested. Although the clinical use of phages has not been approved yet, except a few Eastern European countries, this study exhibits the potential use of the topical bacteriophage therapy in the treatment of complicated SSTIs caused by MDR pathogens with limited treatment options, such as diabetic foot, decubitus, and surgical wound infections.

Development of Mushroom-Based Cosmeceutical Formulations with Anti-Inflammatory, Anti-Tyrosinase, Antioxidant, and Antibacterial Properties

“…This environmental stress generated from ROS and reactive nitrogen species (RNS), combined with increased secretion of inflammatory mediators and enzyme expression (e.g., collagenase and elastase), causes inflammation and decreases the tensile strength and elasticity of the skin [3]. Also in the antimicrobial domain, the incidence of skin and soft tissue infections is growing as a consequence of increasing bacteria resistance to drugs in a wide clinical spectrum [4].…”

Application of Phagotherapy in the Treatment of Burn Patients (Review)

“…A group of scientists from Turkey [ 97 ] has studied in vitro the sensitivity of resistant microorganisms, isolated from patients with complicated infections of soft tissues, to the standard bacteriophage (phage) cocktails. The results demonstrate a high potential of topical bacteriophage therapy in the management of complicated soft tissue infections.…”

Isolation of a lytic bacteriophage against extensively drug‐resistant Acinetobacter baumannii infections and its dramatic effect in rat model of burn infection

“…Nowadays, the use of bacteriophage as an alternative antibacterial drug against various infectious diseases has been reported. Phage therapy would be suggested as a promising antibacterial alternative, in cases where current antibiotics cannot control infections 19–22 . On the other hand, previous studies in food and water treatment, biocontrol, and care have shown that the future applications of bacteriophages will be clear and promising 23,24 .…”

“…Phage therapy would be suggested as a promising antibacterial alternative, in cases where current antibiotics cannot control infections. [19][20][21][22] On the other hand, previous studies in food and water treatment, biocontrol, and care have shown that the future applications of bacteriophages will be clear and promising. 23,24 So far, numerous lytic phages have been isolated against MDR A. baumannii, which have been used in successful clinical trials.…”