The potential of bacteriophages in the treatment of burn wounds.

Bacteriophages were identified in 1915 and have been used since 1919. Despite the prevalence of their application the first users did not understand the nature of bacteriophages, thus, the efficiency of phage therapy proved controversial. Phage therapy was replaced by antibiotics. Fortunately, some centers in Middle and Eastern Europe continued research on bacteriophages. The renaissance of phage therapy was an obvious consequence of the increased percentage of hospital infections caused by multi drug-resistant strains (1). Burn wound infections are a major problem in the recovery process, considering patients with III degree burns, where survival is determined by the severity of the burn and burnrelated infections. Microbial infections which appear during the initial 24 hours are drugresistant and enhance the complexity of the therapeutic problem. The more and more common alternative to antibiotics, widespread by Polish and Georgian centers is the use of phage therapy (2). Based on study results it is estimated that phage therapy is effective in 80% of Enterococcus infections, and even in 90% of Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae infections. Bacteriophages may be effectively used in the treatment of burn wounds, especially opportunistic pathogens such as Pseudomonas spp (2). One of the most important areas of phagotherapy interest are gram-negative bacteria, which show multi-drug resistance. Pseudomonas aeruginosa is the flagship member of the above-mentioned and at the same time an etiologic factor of infection with questionable therapeutic success of antibiotics. Simultaneously, Pseudomonas aeruginosa displays a number of properties, which make it a suitable target for phagotherapy, including the creation of a biofilm, which is hydrolized during the phage infection (1). Studies in mice, infected with resistant to imipenem P. aeruginosa, who developed bacteremia and died within 24 hours, is evidence of the high efficacy of phage ØA392, which was represented by 100% of survival of mice. The phage remained in circulation for 48 hours, that is until complete bacterial eradication without resulting in an unspecific immunological response (3). The biggest problem in the treatment of burn wounds is their infection, which often prevents skin grafting. Studies demonstrated that the use of phages, prior to grafting, hinders P. aeruginosa growth, but also has a positive effect on wound healing (1). Based on clinical and laboratory study results with the use of bacteriophages, one may come to the conclusion that the above-mentioned lead to faster recovery from septic com-