title: The Effectiveness of Bacteriophages against Methicillin-Resistant Staphylococcus aureus ST398 Nasal Colonization in Pigs.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is an important colonizer in animals and an opportunistic pathogen in humans. In humans, MRSA can cause infections that might be difficult to treat because of antimicrobial resistance. The use of bacteriophages has been suggested as a potential approach for the control of MRSA colonization to minimize the-often occupational-exposure of humans. The aim of this study was to assess the efficacy of bacteriophage treatment on porcine nasal colonization with MRSA in vitro, in vivo, and ex vivo. The effectiveness of a bacteriophage combination of phage K*710 and P68 was assessed in vitro by incubating them with MRSA V0608892/1 (ST398) measuring the OD600 hourly. To study the in vivo effect, bacteriophages were administered in a gel developed for human application, which contain 109 plaque-forming units (pfu)/mL (K and P68 in a 19.25:1 ratio) for 5 days to piglets (N = 8) that were experimentally colonized with the MRSA strain. Eight piglets experimentally colonized were used as a negative control. The MRSA strain was also used to colonize porcine nasal mucosa explants and bacteriophages were applied to assess the ex vivo efficacy of treatment. Bacteriophages were effective in vitro. In vivo, sixteen piglets were colonized with MRSA but the number of CFU recovered after the application of the bacteriophages in 8 piglets was not reduced compared to the control animals (approx. 105 CFU/swab). In the ex vivo model, 108 CFU were used to establish colonization with MRSA; a reduction of colonization was not observed after application of bacteriophages. However, application of mupirocin both in vivo and ex vivo resulted in a near eradication of MRSA.
  
  
  CONCLUSIONS
  i) The MRSA strain was killed in the presence of the bacteriophages phage K*710 and P68 in vitro. ii) Bacteriophages did not reduce porcine nasal colonization in vivo or ex vivo. Physiological in vivo and ex vivo conditions may explain these observations. Efficacy in the ex vivo model matched that of the in vivo system.
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
authors.forename: Koen M
authors.initials: KM
authors.lastname: Verstappen
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
authors.forename: Pawel
authors.initials: P
authors.lastname: Tulinski
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Duim
authors.affiliation: Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Ad C
authors.initials: AC
authors.lastname: Fluit
authors.affiliation: Novolytics Ltd., Warrington, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carney
authors.affiliation: Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: van Nes
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.|Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands.
authors.forename: Jaap A
authors.initials: JA
authors.lastname: Wagenaar
mesh_terms: D000818:Animals; D001435:Bacteriophages / Q000502:physiology*; D002478:Cells, Cultured; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development* / Q000821:virology*; D008826:Microbial Sensitivity Tests; D009297:Nasal Mucosa / Q000166:cytology / Q000382:microbiology; D009666:Nose / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000628:therapy* / Q000662:veterinary; D013552:Swine; D013553:Swine Diseases / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome