In clinical contexts, mechanical debridement has also been applied as a routine care procedure before phage application. Patey et al. (117) summarized the outcomes of 15 compassionate phage therapy treatments (from 2006 to 2018) in patients suffering from osteoarticular infections caused predominantly by S. aureus monospecies biofilms and, more rarely, polymicrobial infections with the presence of P. aeruginosa and E. coli. The results of the treatments were very satisfactory, with 12 of 15 patients completely recovered. The therapeutic procedure consisted of a prior debridement and cleaning of the infectious foci, followed by the application of the phage preparation (117).
在临床中，机械清创也被作为噬菌体应用前的常规护理程序。Patey 等人（117）总结了 15 次噬菌体治疗（从 2006 年到 2018 年）的结果，治疗对象主要是由金黄色葡萄球菌单菌种生物膜引起的骨关节感染患者，更罕见的是由铜绿假单胞菌和大肠杆菌引起的多菌感染患者。治疗效果非常令人满意，15 名患者中有 12 人完全康复。治疗过程包括先清创和清洗感染灶，然后使用噬菌体制剂 ( 117)。
4.1.2. Phages to control biofilms in medical devices.
4.1.2.噬菌体控制医疗器械中的生物膜。
Biofilm formation in medical devices (e.g., catheters, cardiac pacemakers, implants, contact lenses, endotracheal tubes, and others) is a common cause of serious infections, which are responsible for a high number of deaths in health care settings (118). In this context, phages may play an important role in preventing or even controlling device-related infections in clinical environments.
医疗器械（如导管、心脏起搏器、植入物、隐形眼镜、气管插管等）中生物膜的形成是造成严重感染的常见原因，也是医疗机构中大量死亡的原因之一 ( 118)。在这种情况下，噬菌体可能会在预防甚至控制临床环境中与器械相关的感染方面发挥重要作用。
Because one of the major challenges in health care settings is prevention of catheter-associated infections, Curtin & Donlan (119) used an in vitro system to study the efficacy of phages as a pretreatment of hydrogel-coated silicon catheters to prevent S. epidermidis biofilms. The authors observed a significant reduction of biofilm formation in phage-treated catheters, suggesting that this may be a promising approach to prevent device-associated infections. Using a similar in vitro model, Fu et al. (38) developed a phage cocktail to prevent P. aeruginosa biofilm formation. Although the phage pretreatment significantly reduced biofilm formation on catheters, phage-resistant variants were isolated during the experiment. The potential of phages to prevent or control biofilms in catheters has also been widely studied against P. mirabilis, the leading cause of catheter-associated urinary tract infections, and promising results were reported in these studies (77, 78, 120).
由于预防导管相关感染是医疗机构面临的主要挑战之一，Curtin 和 Donlan（119）使用体外系统研究了噬菌体作为水凝胶涂层硅导管的预处理来预防表皮葡萄球菌生物膜的功效。作者观察到噬菌体处理过的导管中生物膜的形成明显减少，这表明这可能是一种很有前景的预防器械相关感染的方法。Fu 等人（38）使用类似的体外模型，开发了一种噬菌体鸡尾酒来防止铜绿假单胞菌生物膜的形成。虽然噬菌体预处理大大减少了导管上生物膜的形成，但在实验过程中还是分离出了噬菌体抗性变体。噬菌体在预防或控制导管生物膜方面的潜力也得到了广泛的研究，这些研究针对的是导致导管相关性尿路感染的主要原因–奇异变形杆菌（P. mirabilis），研究结果令人鼓舞（77、78、120）。
Another interesting application is the use of phages for biofilm prevention or control in biomaterial surfaces. In a recent study, Bouchart et al. (121) assessed whether the Remus phage loaded on a calcium phosphate–based ceramic device was able to prevent biofilm colonization. The authors reported that the phage was able to not only prevent S. aureus biofilm initiation but also destroy established biofilms formed on microtiter plates. In addition, they observed that Remus phage was safe for osteoblastic cell proliferation, leading them to conclude that the phage-loaded material could be a good strategy to prevent bacterial infections in bone and joint surgery (121).
另一个有趣的应用是利用噬菌体预防或控制生物材料表面的生物膜。在最近的一项研究中，Bouchart 等人 ( 121) 评估了装载在磷酸钙基陶瓷装置上的 Remus 噬菌体是否能够防止生物膜定植。作者报告说，噬菌体不仅能阻止金黄色葡萄球菌生物膜的形成，还能破坏微孔板上已形成的生物膜。此外，他们还观察到 Remus 噬菌体对成骨细胞的增殖是安全的，因此得出结论认为，噬菌体负载材料可能是预防骨关节手术中细菌感染的良好策略 ( 121)。