Table 2.

Management details, results, and outcomes

NO.	Author		mono or cocktail BT	BT used	Route of BT administration	Follow up	BT related complications	Results and outcomes
1	Ferry et al		cocktail	PhagoDAIR: A mixture of P aeruginosa and the S aureus phages was used. Three Phages (1493, 1815, and 1957) + SAT	IA	18 months	None	The authors reported that the patient developed acute hematogenous Citrobacter koseri hip infection, managed by a new DAIR procedure (intraoperative samples did not grow S aureus). By the last follow up, the outcome was favorable without any clinical signs of persistent infection
2	Doub et al.		monophage	phage SaGR51Φ1 + SAT	IA (with each debridement and with final prosthesis implantation) + IV for 3 days	NR	Transaminitis related to IV phage therapy administration which was reversible and non-life-threatening. No complications of repeated IA administration.	Satisfactory outcomes, limb salvage instead of amputation, reimplantation of a Megaprostheses.
3	Ferry et al.		cocktail	phages PP1493 and PP1815	IA (Phage within DAC hydrogel)	12 months	None	Although phage therapy was used as a salvage procedure as the patient refused transfemoral amputation, The authors reported that the surgery failed due to bleeding and hematoma formation after receiving antiplatelet therapy (to treat myocardial infarction) with subsequent exposure of the free flap and re-infection; however, a bacterial culture of the hematoma revealed superinfection with Pseudomonas aeruginosa, Achromobacter spp., and Proteus mirabilis in culture. No S. aureus grew in culture (which was the target of the phage therapy)
4	Ferry et al. (series of 3 cases)	1	cocktail	PhagoDAIR (PP1493, PP1815, and PP1957) + SAT	IA	30 months	None	The patient had a serous discharge at 3 months which required a new DAIR procedure that showed non-specific synovitis and no infection recurrence. By the last follow up, the patient had a satisfactory outcome, limb and implant salvage, no recurrence or superinfection
		2	cocktail	PhagoDAIR	IA	7 months	None	Satisfactory outcomes, limb and implant salvage, no signs of infection, and pain-free walking.
		3	cocktail	PhagoDAIR	IA	11 months	None	Persistent discharge at 4 months required new DAIR procedures; cultures obtained during the procedure revealed no infection. By the last follow up, the patient had pain-free walking and no recurrence of infection.
5	Tkhilaishivili et al		monophage	bacteriophage therapy against MDR P. aeruginosa (no specific therapy was mentioned) + SAT	During the 1st stage of surgery(debridement and cement spacer), phage therapy was administered IA, followed postoperatively by IA infusion through drain tubes	10 months	None	After 2 weeks of the 1st stage of surgery, the patient experienced purulent discharge, upon which the authors decided to perform another session of debridement and change the spacer; the sample obtained during this surgery showed methicillin-resistant Staphylococcus epidermidis growth (treated with antibiotics) but no P. aeruginosa (which was the target of phage therapy). By the last follow up, the patient had satisfactory outcomes, no knee pain, functional range of motion, no loosening, and no infection recurrence.
6	Cano et al.		monophage	phage KpJH46Φ2 + SAT	IV (40 doses, each dose was taken on a weekday)	8.5 months	None	Satisfactory outcomes, limb salvage instead of amputation option, no recurrence of infection, implants were retained.
7	Doub et al		monophage	DAIR+ phage PM448 + SAT	IA + IV	5 months	A transient increase in aspartate aminotransferase (AST) and alanine aminotransferase (ALT), upon which the IV therapy was stopped owing to patient concerns and requests.	The patient was sent home after five days of the procedure. Satisfactory outcomes, limb salvage, implants were retained, and full knee function. (The authors reported that the patient was suffering from aplastic anemia, which was improved after phage therapy)
8	Ferry et al		cocktail	Arthroscopic debridement and the local application of phages, Three phages: PP1450, PP1777, and PP1792. + SAT	IA	12 months	None	By the last follow up, the knee joint was normal with painless motion and walking. No infection recurrence.
9	Neuts et al		cocktail	phages: Pyophage and IntestiPhage +SAT	oral suspension (for 19 days as a start, then a 2-week pause, followed by another 19 days of therapy).	36 months	None	Limb salvage after the patient refused the Girdlestone option, a favorable outcome, no hip complaints, no infection recurrence.
10	Ramirez-Sanchez et al		Cocktail	Three phages were used for the first treatment cycle: J-Sa36, Sa83, and Sa87. + SAT For the second treatment cycle, a single phage was used: SaGR51ø1. + SAT	For both treatment cycles, phage therapy was administered IA + IV (1st cycle was IA injection followed by IV therapy for 2 weeks) (2nd cycle was IA during the first stage of 2 stages revision)	14 months (Calculated from the 2nd treatment cycle)	None	The patient developed a recurrent infection after the 1st cycle of management, upon which she underwent two stages revision, during which she received the 2nd cycle of management. Satisfactory outcomes, limb salvage after the patient refused the above knee amputation option, no recurrence of infection, and samples from the synovial fluid showed no bacterial growth till the last follow up.
11	Schoeffel et al. knee and hip joints		monophage	Phage SaWIQ0488ø1 + SAT	IA + IV (Phage therapy was administered twice, the first was during debridement sessions for both hip and knee joints and after inserting a temporary spacer, where the patient received both IA and IV, and the second was during the implantation of the final prosthesis, during which the authors mentioned that the patient received only IA phages therapy)	11 months	A slight transaminitis did not lead to phage therapy holding and returned to normal levels after treatment stoppage.	Satisfactory outcomes, samples obtained during the final implantation of the prosthesis for both hip and knee joints revealed no bacterial growth; the patient is ambulating without a cane, able to climb stairs, and driving. No recurrence of infection.

BT Bacteriophage therapy, SAT Suppressive antibiotic therapy, IV Intravenous, IA Intraarticular, NR Not reported, DAIR Debridement, antibiotics, and implant retention, DAC Defensive Antibacterial Coating