Phage therapy in patients with urinary tract infections: a systematic review

Abstract

Introduction: Urinary tract infections (UTIs) caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria are challenging to treat. This systematic review evaluates bacteriophage therapy. Research design and methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, and Cochrane databases. Studies reporting bacteriophage therapy in UTIs, with outcomes related to safety and efficacy, were included. Studies unrelated to UTIs or lacking clear outcomes were excluded. Bias was assessed using RoB2 and JBI appraisal tools for series and case reports. Data were synthesized narratively due to study heterogeneity. Results: From 576 articles screened, 12 studies met the inclusion criteria, comprising 89 participants, many with MDR and XDR infections. Phage therapy was generally well-tolerated. Efficacy varied, with some studies showing complete infection resolution, particularly in high-risk patients, while others reported partial or no improvement. Phage therapy often served as the sole viable treatment for XDR infections, yielding positive results despite small sample sizes and data heterogeneity. Conclusions: Phage therapy shows promise as an alternative or adjunct to antibiotics for UTIs, especially those with limited treatment options, but uncertainties remain regarding dosing and administration. Further randomized trials are needed to confirm its efficacy and safety. Protocol registration: www.crd.york.ac.uk/prospero identifier isCRD42023431617.