Эффективность использования бактериофагов для лечения и профилактики инфекции: систематический обзор

Successful implementation of lytic virulent bacteriophages in clinical practice requires convincing evidence of its safety and efficacy. Design: We searched in CENTRAL, MEDLINE, Embase, and Russian-language literature databases in May 2018. Original articles must fulfill the following eligibility criteria: randomized controlled trials investigating the effects of phage therapy in people with bacterial infections; at least one patient outcome was reported. Three review authors independently selected studies, extracted data, and assessed risk of bias. We used random-effects models for meta-analysis. Participants: adults and children of both sexes with bacterial infection, including multi-drug resistant variants, or individuals at risk of infection. Outcomes: recovery or resolution of infection; clinical improvement; change in number of exacerbations; recurrence of infection; quality of life; elimination or load reduction of a pathogen in an anatomical compartment. Results: We included 13 trials (issued in 1965-2018) including 9 treatment studies and 4 prevention studies. Overall, eight randomized trials involved adults. Five studies addressed skin and soft tissues infections, six studies concerned intestinal infections, one study addressed respiratory tract infection and one study – ear infection. Across bias domains, 35-90% of trials scored low risk of bias. Meta-analysis for adverse events attributable to phages and for wound healing provided us with pooled relative risks of 0.74 (95% CI 0.68;1.2) and 0.91 (95% CI 0.68;1.2) respectively. Conclusions: Beneficial effect of bacteriophages can be demonstrated and not refuted. However, our study led to tentative conclusions. The conduct of well-designed and sufficiently powered trials would facilitate registration and wide accepting of bacteriophage treatment.