Bacteriophage therapy against Pseudomonas aeruginosa biofilms: a review
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Annals of Clinical Microbiology and Antimicrobials Open Access
REVIEW
Bacteriophage therapy against Pseudomonas aeruginosa biofilms: a review Zahra Chegini1, Amin Khoshbayan2, Majid Taati Moghadam1, Iman Farahani3 , Parham Jazireian4 and Aref Shariati5*
Abstract Multi-Drug Resistant (MDR) Pseudomonas aeruginosa is one of the most important bacterial pathogens that causes infection with a high mortality rate due to resistance to different antibiotics. This bacterium prompts extensive tissue damage with varying factors of virulence, and its biofilm production causes chronic and antibiotic-resistant infections. Therefore, due to the non-applicability of antibiotics for the destruction of P. aeruginosa biofilm, alternative approaches have been considered by researchers, and phage therapy is one of these new therapeutic solutions. Bacteriophages can be used to eradicate P. aeruginosa biofilm by destroying the extracellular matrix, increasing the permeability of antibiotics into the inner layer of biofilm, and inhibiting its formation by stopping the quorum-sensing activity. Furthermore, the combined use of bacteriophages and other compounds with anti-biofilm properties such as nanoparticles, enzymes, and natural products can be of more interest because they invade the biofilm by various mechanisms and can be more effective than the one used alone. On the other hand, the use of bacteriophages for biofilm destruction has some limitations such as limited host range, high-density biofilm, sub-populate phage resistance in biofilm, and inhibition of phage infection via quorum sensing in biofilm. Therefore, in this review, we specifically discuss the use of phage therapy for inhibition of P. aeruginosa biofilm in clinical and in vitro studies to identify different aspects of this treatment for broader use. Keywords: MDR P. aeruginosa, Biofilm, Bacteriophage, Antibiofilm effects Introduction Pseudomonas aeruginosa is a Gram-negative bacillus and one of the main opportunistic pathogens that have a leading role in nosocomial, acute, and chronic infections [1]. Infection with this pathogen leads to diseases with a high mortality rate in patients diagnosed with cystic fibrosis, cancer, severe burns, and immunocompromised patients [2, 3]. This bacterium can survive on water, different surfaces, and medical devices by using its influential binding factors such as flagella, pili, and biofilms. Thus, P.
*Correspondence: [email protected]; [email protected] 5 Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article
aeruginosa is abundant in natural and artificial environments, lakes, hospitals, and household sink drains [4]. Due to the widespread role of this bacterium in causing various infections and increasing antibiotic resistance, recently, the treatment failure has become a major global problem. P. aeruginosa has shown high intrinsic resistance to a range of antibiotics, including beta
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