Engineered phage therapy for the effective treatment of recurrent Carbapenem-resistant Enterobacteriaceae infections: A hypothesis

The increasing rate of Carbapenem-resistant Enterobacteriaceaer (CRE) infections poses a significant threat to global public health. Patients infected with CRE often experience frequent recurrences after antibiotic treatment, making it difficult to cure. The design of better antimicrobials that can not only kill CRE but also disrupt biofilms and eliminate persister cells will play a crucial role in improving antibacterial efficacy and preventing recurrent infections. In this hypothesis, we employ an innovative “water pipe” theory to elucidate the potential underlying causes of CRE infection recurrence. We propose a potential therapeutic approach utilizing engineered phages to combat CRE infections, demonstrating the mechanism of action of phages carrying lytic enzymes or antimicrobial peptides against biofilms and persister cells. Furthermore, we evaluate its efficacy and feasibility, which may effectively address the recurrence of CRE infections and reduce antibiotic usage.