Bacteriophage therapy plus fecal microbiota transplantation to treat recurrent urinary tract infection (rUTI): a case series

Recurrent urinary tract infections (rUTIs) are a chronic, debilitating condition characterized by repeated infections and treatment failure with antibiotics. We present an attempt to decolonize the urinary and intestinal reservoirs between acute UTI episodes in three female patients suffering from rUTI caused by Escherichia coli using a combined approach of semi-personalized phage therapy followed by fecal microbiota transplantation (FMT). Patients with long-term urinary detection of phage-susceptible E. coli received eight days of oral and intravesical phage application followed by antibiotics prior to FMT. Pathogen titers decreased significantly after local administration, and phage concentrations were maintained in the urine between doses after several days. While E. coli was detected in follow-up samples, patients experienced less frequent and less severe episodes of acute UTI 24 months post-treatment. Genetic analysis of pre- and post-treatment strains revealed a strain replacement for one patient. Metagenomic shotgun sequencing of stool samples confirmed engraftment in FMT recipients.