Bacteriophage therapy a promising alternative treatment approach for infections caused by multidrug-resistant (MDR) Enterococcus species

Abstract

The 21st-century real threat is the upsurge of microbial resistance and the ineffectiveness of drugs to even a minor injury and common infection, which further leads to an increase in mortality rate. Enterococci bacterial species, such as Enterococcus faecalis and Enterococcus faecium, are common human pathogens that cause many diseases, such as bacteremia, urinary tract infections (UTI), meningitis, and endocarditis. The higher occurrence of MDR bacteria and the ineffectiveness of available antibiotics in treating infectious diseases have prompted a search for viable alternatives, such as bacteriophage therapy and combinational therapy of bacteriophage with standard antibiotics. The current review focuses on the role of Enterococcus spp. as the causative agent of life-threatening infections and how the bacteriophages are effective against them in reference to different clinical settings and their ability to thwart biofilm formation. Furthermore, combining antibiotics and bacteriophage improves killing efficacy and prevents phage resistance development. Compared to conventional antibiotics alone, the synergy between the antibiotics and phages disrupts the biofilm efficiently in MDR biofilm infections. Finally, the application of bacteriophage endolysin has been discussed, gathering significant attention worldwide due to their cell wall lysing propensity and potential therapeutic usage for treating enterococci-associated infectious diseases. © 2025