Bacteriophage therapy as an alternative approach: The future of phage-based treatments in combating antibiotic resistance

The rapid rise of antimicrobial resistance has weakened the clinical value of many antibiotics and complicated the management of burn wound infections. This study investigated bacterial pathogens recovered from burn wounds in Ramadi City andevaluated wastewater-derived bacteriophages as a targeted option against drug-resistant isolates. A total of 100 burn wound swabs were collected from patients (12-65 years) at Ramadi City Hospital between September 15, 2024, and January 17, 2025. Isolates were cultured on selective media, identified by microscopy and biochemical testing, and confirmed using the VITEK_2 Compact system. Antimicrobial susceptibility was assessed by the Kirby–Bauer disk diffusion method using 12 antibiotic disks interpreted according to CLSI 2024. Biofilm production was screened, and molecular confirmation was performed using conventional PCR targeting the 16S rRNA gene with electrophoretic visualization and sequencing for verification. Environmental wastewater samples from a local wastewater filling station were used for phage enrichment, isolation by the double agar layer method, plaque purification, and morphological characterization by transmission electron microscopy (TEM). Eighty-six bacterial isolateswere obtained from the 100 samples; 14 samples showed no growth. Staphylococcus aureus was the predominant organism (54%), followed by Pseudomonas aeruginosa (9%), Klebsiella pneumoniae (7%), Escherichia coli (5%),Enterobacter aerogenes (4%), and Serratia marcescens (3%), with several species detected as single isolates. Lytic bacteriophages were recovered only against S. aureus; no lytic activity was observed against E. coli, P. aeruginosa, or K. pneumoniae under the conditions tested. TEM revealed tailed phage particles consistent with common staphylococcal bacteriophages. Overall, wastewater-derived phages showed strong host specificity for S. aureus, supporting further work to optimize isolation conditions, expand host-range screening, and evaluate combined phage-antibiotic strategies for burnwound infections.