Randomized Controlled Study on the Safety and Efficacy of Phage Cocktail in the Treatment of Multidrug-Resistant Bacterial Skin Infections

NCT07619924 | Enrolling By Invitation Early Phase 1

• 1 other identifier: 2025YFC3408505
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

This study addresses the increasingly severe global public health challenge of antibiotic resistance, focusing on exploring phage therapy as a potential treatment strategy for multidrug-resistant bacterial skin infections. Bacteriophages, with advantages such as high specificity, low propensity for inducing resistance, and minimal side effects, have shown promise in preliminary clinical research for scenarios like chronic wound infections, demonstrating potential in reducing bacterial load and promoting healing. To this end, the study is designed as a prospective, double-blind, non-inferiority randomized controlled clinical trial, aiming to systematically evaluate the efficacy and safety of phage therapy compared to a placebo or standard treatment in patients with multidrug-resistant bacterial skin infections. The study plans to enroll patients aged 18 to 75 years, clinically diagnosed with a skin infection and with a wound area between 4 and 225 square centimeters. The infection must not involve deep tissue and should be suitable for topical treatment. All enrolled cases must have pathogenic bacteria detected in secretions or wound samples, and these bacteria must be resistant to key antibiotics (such as carbapenems) or show poor response to antibiotic therapy despite \*in vitro\* sensitivity. Patients who have received systemic antibacterial treatment within 72 hours before enrollment with no significant improvement may also be included. Participants of childbearing potential must agree to use effective contraception during the study and voluntarily provide written informed consent. Exclusion criteria primarily include: infections that can be effectively controlled by existing antimicrobials, or pathogens that are insensitive to the phage cocktail used in the study; pregnant or lactating women; patients whose infection symptoms have improved after using antimicrobials within 72 hours before enrollment; those receiving long-term or high-dose corticosteroids, immunosuppressants, chemotherapy, or other treatments that may interfere with the results; participation in other antimicrobial-related clinical trials within the past month; presence of severe wound infections (e.g., necrotizing fasciitis), chronic inflammatory skin diseases, multiple limb ulcers, non-removable implants, or gangrene; anticipated need for amputation surgery; history of clear allergic diseases, immune deficiency (including HIV positivity), mental disorders, or epilepsy; and any other condition deemed by the investigator as unsuitable for participation. These strict inclusion and exclusion criteria aim to select an appropriate target population, ensuring the scientific rigor and credibility of the study results.

Conditions

Phage Therapy; Bacteriophage Therapy; Skin and Soft Tissue Infections

Outcome Measures

Primary Outcomes (2)

• Clinical Cure Rate at End of Treatment

  Defined as the proportion of patients achieving complete resolution of infection-related clinical symptoms without requiring additional antimicrobial intervention.

  From enrollment to the end of the 7-day treatment period.

• Microbiological Eradication Rate

  The proportion of patients with eradication (or reduction below the detection limit) of the baseline pathogen, as confirmed by wound culture.

  From enrollment to Day 14 (7 days post-treatment).

Secondary Outcomes (5)

• Wound Size Reduction

  From enrollment to Day 7, Day 14, and Day 28.

• Time to Cessation of Exudate

  From enrollment through Day 28 follow-up.

• Incidence of Treatment-Emergent Adverse Events

  From enrollment through Day 28 post-treatment.

• Recurrence/Reinfection Rate within Follow-up

  From the end of treatment through the Day 28 follow-up visit.

• Patient-reported Pain Score

  From enrollment to Day 7, Day 14, and Day 28.

Study Arms (2)

Bacteriophage Treatment Group

EXPERIMENTAL

Receive bacteriophage cocktail therapy for 7 days, combined with antibiotic therapy and conventional treatment.

Biological: Bacteriophage Treatment

Placebo Group

PLACEBO COMPARATOR

Receive 0.9% normal saline (placebo) for 7 days, combined with antibiotic therapy and conventional treatment.

Drug: Placebo treatment using 0.9% normal saline

Interventions

Bacteriophage Treatment BIOLOGICAL

Bacteriophage therapy for skin and soft tissue infections typically involves the targeted application of bacteriophage preparations directly to the infected site. Bacteriophage therapy for skin infections involves topical application of phage cocktails to the infected site. These phages specifically target and lyse drug-resistant bacteria, can penetrate biofilms, and are often used alongside standard wound care. Treatment is typically administered daily for 1-2 weeks, focusing on reducing bacterial load and promoting healing with minimal disruption to normal flora.

Bacteriophage Treatment Group

Placebo treatment using 0.9% normal saline DRUG

In this double-blind clinical trial, 0.9% normal saline serves as the placebo, designed to be indistinguishable from the active bacteriophage cocktail in formulation, packaging, and appearance. It is administered identically: following standard wound cleaning, a measured volume is applied topically to the wound and covered with the same sterile dressing. The treatment schedule-frequency, duration, and concomitant background care including systemic antibiotics and routine wound management-is strictly standardized across all participants. This ensures any outcome difference is attributable only to the topical agent. Sterile, single-use saline meeting pharmacopeial standards is used to prevent contamination. Blinded researchers assess efficacy and safety at predefined intervals by monitoring wound parameters, bacterial load, and adverse events, maintaining trial integrity for a valid evaluation of the phage therapy's specific effect.

Placebo Group

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• (1) Aged 18 to 75 years, regardless of gender.
• (2) Clinically diagnosed with a skin infection, with an infected wound area of 4-225 cm².
• (3) The infection does not involve deep tissues, is suitable for topical treatment, and is not expected to require surgical intervention.
• (4) Pathogenic bacteria are detected in secretions or wound samples.
• (5) The pathogen is resistant to key antibiotics (such as carbapenems, etc.), or, despite being susceptible in vitro, shows poor response to antibiotic therapy.
• (6) Patients who have received systemic antibacterial therapy within 72 hours prior to enrollment without significant improvement may also be included.
• (7) Subjects of childbearing potential must agree to use effective contraception during the study period.
• (8) Voluntarily sign the informed consent form, and are willing and able to comply with the requirements of the study protocol.

You may not qualify if:

• (1) The infection can be effectively controlled by available antimicrobial agents, or the causative pathogen is insensitive to the phage cocktail used in this study.
• (2) Pregnant or breastfeeding women. (3) Patients who have used antimicrobial agents within 72 hours prior to enrollment and have shown improvement in infection symptoms.
• (4) Patients currently receiving prolonged or high-dose corticosteroids, immunosuppressants, chemotherapy, or other treatments that may interfere with the study results.
• (5) Patients who have participated in other clinical trials related to antimicrobial agents within the past month.
• (6) Patients with severe wound infections (e.g., necrotizing fasciitis), chronic inflammatory skin diseases, multiple limb ulcers, non-removable implants, or gangrene, among other conditions.
• (7) Patients expected to require amputation surgery. (8) Patients with a documented history of allergic disorders, immunodeficiency (including HIV positivity), mental disorders, or epilepsy.
• (9) Any other condition deemed by the investigator as unsuitable for participation in this study.

Sponsors & Collaborators

• First Affiliated Hospital Xi'an Jiaotong University: lead

Study Sites (1)

The First Affiliated Hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, 710061, China

Location

Related Publications (12)

• GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024 Sep 28;404(10459):1199-1226. doi: 10.1016/S0140-6736(24)01867-1. Epub 2024 Sep 16.

  PMID: 39299261 BACKGROUND

• Green SI, Clark JR, Santos HH, Weesner KE, Salazar KC, Aslam S, Campbell JW, Doernberg SB, Blodget E, Morris MI, Suh GA, Obeid K, Silveira FP, Filippov AA, Whiteson KL, Trautner BW, Terwilliger AL, Maresso A. A Retrospective, Observational Study of 12 Cases of Expanded-Access Customized Phage Therapy: Production, Characteristics, and Clinical Outcomes. Clin Infect Dis. 2023 Oct 13;77(8):1079-1091. doi: 10.1093/cid/ciad335.

  PMID: 37279523 BACKGROUND

• Khatami A, Lin RCY, Petrovic-Fabijan A, Alkalay-Oren S, Almuzam S, Britton PN, Brownstein MJ, Dao Q, Fackler J, Hazan R, Horne B, Nir-Paz R, Iredell JR. Bacterial lysis, autophagy and innate immune responses during adjunctive phage therapy in a child. EMBO Mol Med. 2021 Sep 7;13(9):e13936. doi: 10.15252/emmm.202113936. Epub 2021 Aug 9.

  PMID: 34369652 BACKGROUND

• Ding X, Tang Q, Xu Z, Xu Y, Zhang H, Zheng D, Wang S, Tan Q, Maitz J, Maitz PK, Yin S, Wang Y, Chen J. Challenges and innovations in treating chronic and acute wound infections: from basic science to clinical practice. Burns Trauma. 2022 May 21;10:tkac014. doi: 10.1093/burnst/tkac014. eCollection 2022.

  PMID: 35611318 BACKGROUND

• Kohler T, Luscher A, Falconnet L, Resch G, McBride R, Mai QA, Simonin JL, Chanson M, Maco B, Galiotto R, Riat A, Civic N, Docquier M, McCallin S, Chan B, van Delden C. Personalized aerosolised bacteriophage treatment of a chronic lung infection due to multidrug-resistant Pseudomonas aeruginosa. Nat Commun. 2023 Jun 27;14(1):3629. doi: 10.1038/s41467-023-39370-z.

  PMID: 37369702 BACKGROUND

• Dedrick RM, Freeman KG, Nguyen JA, Bahadirli-Talbott A, Smith BE, Wu AE, Ong AS, Lin CT, Ruppel LC, Parrish NM, Hatfull GF, Cohen KA. Potent antibody-mediated neutralization limits bacteriophage treatment of a pulmonary Mycobacterium abscessus infection. Nat Med. 2021 Aug;27(8):1357-1361. doi: 10.1038/s41591-021-01403-9. Epub 2021 Jul 8.

  PMID: 34239133 BACKGROUND

• Pirnay JP, Djebara S, Steurs G, Griselain J, Cochez C, De Soir S, Glonti T, Spiessens A, Vanden Berghe E, Green S, Wagemans J, Lood C, Schrevens E, Chanishvili N, Kutateladze M, de Jode M, Ceyssens PJ, Draye JP, Verbeken G, De Vos D, Rose T, Onsea J, Van Nieuwenhuyse B; Bacteriophage Therapy Providers; Bacteriophage Donors; Soentjens P, Lavigne R, Merabishvili M. Personalized bacteriophage therapy outcomes for 100 consecutive cases: a multicentre, multinational, retrospective observational study. Nat Microbiol. 2024 Jun;9(6):1434-1453. doi: 10.1038/s41564-024-01705-x. Epub 2024 Jun 4.

  PMID: 38834776 BACKGROUND

• Liu M, Hernandez-Morales A, Clark J, Le T, Biswas B, Bishop-Lilly KA, Henry M, Quinones J, Voegtly LJ, Cer RZ, Hamilton T, Schooley RT, Salka S, Young R, Gill JJ. Comparative genomics of Acinetobacter baumannii and therapeutic bacteriophages from a patient undergoing phage therapy. Nat Commun. 2022 Jun 30;13(1):3776. doi: 10.1038/s41467-022-31455-5.

  PMID: 35773283 BACKGROUND

• Sulakvelidze A, Alavidze Z, Morris JG Jr. Bacteriophage therapy. Antimicrob Agents Chemother. 2001 Mar;45(3):649-59. doi: 10.1128/AAC.45.3.649-659.2001. No abstract available.

  PMID: 11181338 BACKGROUND

• Mu A, McDonald D, Jarmusch AK, Martino C, Brennan C, Bryant M, Humphrey GC, Toronczak J, Schwartz T, Nguyen D, Ackermann G, D'Onofrio A, Strathdee SA, Schooley RT, Dorrestein PC, Knight R, Aslam S. Assessment of the microbiome during bacteriophage therapy in combination with systemic antibiotics to treat a case of staphylococcal device infection. Microbiome. 2021 Apr 14;9(1):92. doi: 10.1186/s40168-021-01026-9.

  PMID: 33853672 BACKGROUND

• Schooley RT, Biswas B, Gill JJ, Hernandez-Morales A, Lancaster J, Lessor L, Barr JJ, Reed SL, Rohwer F, Benler S, Segall AM, Taplitz R, Smith DM, Kerr K, Kumaraswamy M, Nizet V, Lin L, McCauley MD, Strathdee SA, Benson CA, Pope RK, Leroux BM, Picel AC, Mateczun AJ, Cilwa KE, Regeimbal JM, Estrella LA, Wolfe DM, Henry MS, Quinones J, Salka S, Bishop-Lilly KA, Young R, Hamilton T. Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection. Antimicrob Agents Chemother. 2017 Sep 22;61(10):e00954-17. doi: 10.1128/AAC.00954-17. Print 2017 Oct.

  PMID: 28807909 BACKGROUND

• Chan BK, Stanley GL, Kortright KE, Vill AC, Modak M, Ott IM, Sun Y, Wurstle S, Grun CN, Kazmierczak BI, Rajagopalan G, Harris ZM, Britto CJ, Stewart J, Talwalkar JS, Appell CR, Chaudary N, Jagpal SK, Jain R, Kanu A, Quon BS, Reynolds JM, Teneback CC, Mai QA, Shabanova V, Turner PE, Koff JL. Personalized inhaled bacteriophage therapy for treatment of multidrug-resistant Pseudomonas aeruginosa in cystic fibrosis. Nat Med. 2025 May;31(5):1494-1501. doi: 10.1038/s41591-025-03678-8. Epub 2025 Apr 29.

  PMID: 40301561 RESULT

Related Links

• Related Info

MeSH Terms

Conditions

Soft Tissue Infections

Interventions

Saline Solution

Condition Hierarchy (Ancestors)

Infections

Intervention Hierarchy (Ancestors)

Crystalloid Solutions; Isotonic Solutions; Solutions; Pharmaceutical Preparations

Study Design

• Study Type: interventional
• Phase: early phase 1
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 27, 2026
• First Posted: June 2, 2026
• Study Start: January 15, 2025
• Primary Completion (Estimated): October 31, 2027
• Study Completion (Estimated): May 1, 2028
• Last Updated: June 2, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)