New and innovative strategies in order to overcome antibiotic resistance: a focus on phage therapy and fecal microbiota transplantation

Antibiotic resistance is becoming an emerging threat to human health especially in hospitalized patients which have often medical devices such as catheters and prosthetic implants. Few bacteria can be naturally resistant to antibiotics, but many of them gradually become resistant due to the suboptimal level of antibiotics or the use of antibiotics even when they are not necessary or when the pathogen is unknown, and therapy needs to cover all the possible infections especially in the emergency settings. In the hospital settings, where there are major chances for a pathogen to be resistant -due to the selective pressure of the sterile environment, it might pass the resistance genes to a previously sensitive strain. The overuse and misuse of antibiotics due to misinformation has led to the selection of pan-antibiotic resistant bacteria capable of colonizing the host microbiota and to resist nearly to all the available antibiotics.
New and innovative strategies are being improved in order to overcome antibiotic resistance: 1) European one-health strategy able to coordinate the attentive use of antibiotics in human field, in the environment and also in the animal care; 2) Bacteriophage therapy, which has been rediscovered and revaluated since the beginning of the 1900s; 3) Fecal Microbiota Transplantation (FMT), which is based on the definition and study of healthy human donors’ microbiota in order to find and specifically rebuilt the microbiota of sick patients. Bacteriophage therapy and FMT cannot be considered as standard therapies because of their biological profile; at present, studies and research are being performed in order to build a specific legislation which might standardise their preparation for therapy administration at industrial level, but, currently, only ad-hoc specific patients therapies can be prepared.