Clinical Phage Microbiology:A suggested framework and recommendations for the in-vitro matching steps of phage therapy

Personalized-phage-therapy is a promising solution for the emerging crisis of bacterial infections that fail to be eradicated by conventional antibiotics. One of the most crucial elements of personalized-phage-therapy is the proper matching of phages and antibiotics to the target bacteria in a given clinical setting. However, to date, there is no consensus guideline for laboratory procedures that enable in vitro evaluation of phages intended for treatment. In this work, we suggest a framework and strategies identify appropriate phages and combine them with antibiotics in clinical microbiology laboratories. This framework, which we term here "Clinical Phage Microbiology" is based on our experience and other previously reported cases of both, successful and failed phage treatments. Additionally, we discuss troubleshooting methodologies for possible pitfalls and special cases that may need to be assessed before treatment including interactions with the host immune system, biofilms, and polymicrobial infections. We believe that the "Clinical Phage Microbiology" pipeline presented here should serve as the basis for standardization of laboratory protocols to match phages for personalized therapy.