Beyond Antibiotics: Phage-Based Approaches for Controlling Biofilm-Associated Pseudomonas aeruginosa Infections: A Review Phage-Based Approaches for Controlling Biofilm-Associated Pseudomonas aeruginosa Infections
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Abstract
Pseudomonas aeruginosa is a pathogen that causes chronic and difficult-to-treat infections, especially in patients with cystic fibrosis, burn wounds, and immunocompromised patients. Its extraordinary ability to establish biofilms and develop multidrug resistance has significantly affected the effectiveness of traditional antibiotic therapy, and the treatment of bacteriophage infections has once again become a subject of scientific concern. This present review provides a general overview of bacteriophage therapy for P. aeruginosa, focusing on the underlying microbiological processes, strategies of biofilm therapy, and progress in clinical translation. Important aspects of phage–host interactions, including adsorption, intracellular replication and bacterial lysis, and factors that determine therapeutic efficacy, such as phage resistance and immune modulation are discussed. The role of phages in destabilizing biofilms of P. aeruginosa by degrading extracellular polymeric substances through enzymatic activity, disrupting quorum sensing, and having synergistic effects with antibiotics and other antimicrobial agents is particularly emphasized. In addition, this review summarized the existing preclinical and clinical information regarding the safety and therapeutic potential of phage therapy in respiratory, wound, and device-associated infections. Issues relating to regulatory guidelines, phage preparations and dosing standardization, and delivery route enhancement are also considered. This review integrates mechanistic knowledge with a translational perspective and introduces bacteriophage therapy as a promising and biologically plausible adjunct or alternative to antibiotics in the management of recalcitrant P. aeruginosa infections and the need to develop well-designed clinical trials to determine the role of phage therapy in routine clinical practice.
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