Resistant urinary tract infection during post antibiotic era - Is it time for revival of phage therapy?

Abstract

Treatment of antibiotic resistant uropathogenic Escherichia coli (UPEC) infection is currently a major challenge in the field of antimicrobial therapeutics. In addition, the evolution of Extended Spectrum Beta Lactamase (ESBL) and bio-film producing UPEC pose further hurdles in treating recurrent urinary tract infection (UTI) due to UPEC. The last decade witnessed emergence of various alternative treatment measures to tide over this crisis, including non-antibiotic agents and vaccines. However, in terms of efficacy, none of these agents fulfil our needs adequately. It appears that we are slowly and surely entering into the post-antibiotic era. This has prompted researchers to turn their attention to re-discover bacteriophage therapy as an alternative for treatment of resistant uropathogens. Phage Bacteriophages (phages) are tiny viruses, which are highly specific to their biological hosts and have been known to the researchers for more than two decades. Despite its demonstrated utility long ago, phage therapy was not in the lime light due to various reasons. These tiny members of the extensive microbiome in the human body are now being reconsidered as alternatives to antibiotics in resistant situations. The phages possess the potential of being used as natural phages (or as cocktail), genetically engineered phages, phage lytic enzymes or phage antibiotic synergy. In this paper, we attempt to review the current status of phage therapy in UPEC and assess whether it is time to incorporate it into treatment practices during this post antibiotic era with widespread chemical therapeutic resistance.