Therapeutic applications of bacteriophage therapy for antibiotic-resistant chronic skin infections: systematic review

Chronic skin infections, exacerbated by antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus, require innovative therapies. Bacteriophage therapy, which utilizes viruses to target and eliminate bacteria that are resistant to antibiotics, presents a promising alternative. However, challenges regarding regulations and standardization remain. This systematic review aims to evaluate the therapeutic potential of bacteriophage therapy in treating antibiotic-resistant chronic skin infections by analyzing data from human clinical applications and identifying implementation issues. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, which included database searches from PubMed, Medline, Web of Science, and Scopus. We employed the keywords (bacteriophage therap* OR phage therap* OR bacteriophage* OR phage*) AND (antibiotic resist* OR antimicrobial resist* OR drug resist* OR drug-resistant) AND (chronic skin infect* OR cutaneous infect* OR soft-tissue infect* OR wound* OR ulcer* OR "diabetic foot ulcer (DFR)*" OR "foot ulcer*" OR "pressure ulcer*" OR "decubitus ulcer*" OR cellulitis OR abscess* OR lesion* OR dermat*). Eight studies were included in the systematic review. The included studies demonstrated that bacteriophage therapy resulted in notable clinical improvements in chronic skin infections, characterized by marked reductions in bacterial load, enhanced wound healing, and radiographic evidence of bone ossification. Studies reported significant efficacy across diverse infection types and pathogens, including multidrug-resistant strains, with minimal transient adverse effects. These results demonstrate the promise of phage therapy as a safe adjunct or alternative to conventional treatments. This review suggests that bacteriophage therapy offers significant clinical benefits with minimal safety concerns, supporting its potential as a viable alternative or adjunct in treating antibiotic-resistant infections, though further robust trials are needed to optimize dosing and address emerging resistance profiles.