{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:55:12Z","timestamp":1790283312682,"version":"4.1.0"},"reference-count":59,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Periprosthetic joint infections (PJI) caused by\n                      <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                      spp., especially vancomycin-resistant strains (VRE), are challenging to treat due to biofilm tolerance and limited antibiotic options. Bacteriophages offer a promising adjunct through targeted and biofilm-disrupting activity. This study evaluated two novel lytic phages, alone and combined with last-line antibiotics, for their ability to eradicate VRE biofilms\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      . Two novel lytic phages, CUB-FM (\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      ) and CUB-FS (\n                      <jats:italic toggle=\"yes\">E. faecalis<\/jats:italic>\n                      ), were isolated from hospital sewage and characterized via whole-genome sequencing and transmission electron microscopy. Antibiofilm efficacy of phages alone and in combination with dalbavancin, daptomycin, and fosfomycin was assessed against biofilm-embedded VRE strains using isothermal microcalorimetry. Synergy was defined as a combined effect exceeding the sum of individual activities. Genomic analysis confirmed both phages as strictly lytic and free of lysogeny, virulence, or resistance genes. TEM classified CUB-FM within\n                      <jats:italic toggle=\"yes\">Salasmaviridae<\/jats:italic>\n                      and CUB-FS within\n                      <jats:italic toggle=\"yes\">Herelleviridae<\/jats:italic>\n                      . Both exhibited dose-dependent antibiofilm activity, with optimal efficacy at 10\u00b9\u00b2 (CUB-FM) and 10\u2078 PFU\/mL (CUB-FS). While antibiotic monotherapies showed limited antibiofilm effects, phage-antibiotic combinations markedly enhanced activity. CUB-FM with dalbavancin achieved the strongest suppression against\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      (t\n                      <jats:sub>Max<\/jats:sub>\n                      22.3 h vs. 5.2 h control,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and CUB-FS with dalbavancin or fosfomycin at \u226510 \u00d7 MIC completely eradicated\n                      <jats:italic toggle=\"yes\">E. faecalis<\/jats:italic>\n                      biofilms. Daptomycin-phage combinations produced additive to synergistic effects. Novel phages CUB-FM and CUB-FS exhibit potent antibiofilm activity and synergize with last-line antibiotics against VRE. Phage-antibiotic combinations, particularly with dalbavancin and fosfomycin, represent a promising strategy for treating biofilm-associated enterococcal PJIs.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Vancomycin-resistant enterococci (VRE) are increasingly implicated in biofilm-associated periprosthetic joint infections, where treatment options are limited, and clinical outcomes are poor. Conventional antibiotics often fail due to reduced biofilm penetration and bacterial tolerance, highlighting the need for novel therapeutic strategies. Our study introduces two newly characterized lytic phages, CUB-FM and CUB-FS, which demonstrated strong antibiofilm activity and synergistic interactions with last-line antibiotics. Notably, phage-antibiotic combinations achieved either additive or synergistic effects, with dalbavancin and fosfomycin-phage therapy leading to a complete eradication of\n                        <jats:italic toggle=\"yes\">E. faecalis<\/jats:italic>\n                        biofilms. These findings provide proof of concept that combining phages with antibiotics enhances efficacy against multidrug-resistant\n                        <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                        biofilms, offering a translational pathway for personalized, adjunctive therapies in complex orthopedic infections. By bridging the gap between genomic phage safety validation and functional synergy testing, this work supports further preclinical and clinical development of phage-antibiotic strategies for refractory implant-associated infections.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01818-25","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T15:17:13Z","timestamp":1763565433000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":2,"title":["Novel lytic phages improve the antibiofilm activity of dalbavancin, daptomycin, and fosfomycin against vancomycin-resistant enterococci"],"prefix":"10.1128","volume":"14","author":[{"given":"Rima","family":"Fanaei Pirlar","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01hcx6992","id-type":"ROR","asserted-by":"publisher"}],"name":"Center for Musculoskeletal Surgery (CMSC), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5137-8818","authenticated-orcid":true,"given":"Alvaro","family":"Irigoyen-von-Sierakowski","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01hcx6992","id-type":"ROR","asserted-by":"publisher"}],"name":"Center for Musculoskeletal Surgery (CMSC), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health","place":["Berlin, Germany"]},{"id":[{"id":"https:\/\/ror.org\/0111es613","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2185-5724","authenticated-orcid":true,"given":"Jeroen","family":"Wagemans","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05f950310","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Biosystems, KU Leuven","place":["Leuven, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2517-8907","authenticated-orcid":true,"given":"Yu","family":"Ning","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01hcx6992","id-type":"ROR","asserted-by":"publisher"}],"name":"Center for Musculoskeletal Surgery (CMSC), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Lavigne","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05f950310","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Biosystems, KU Leuven","place":["Leuven, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-2521","authenticated-orcid":false,"given":"Andrej","family":"Trampuz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03pnv4752","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Medicine, Faculty of Health, Queensland University of Technology","place":["Brisbane, Australia"]},{"id":[{"id":"https:\/\/ror.org\/05p52kj31","id-type":"ROR","asserted-by":"publisher"}],"name":"Royal Brisbane and Women's Hospital","place":["Herston, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9265-5260","authenticated-orcid":true,"given":"Svetlana","family":"Karbysheva","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01hcx6992","id-type":"ROR","asserted-by":"publisher"}],"name":"Center for Musculoskeletal Surgery (CMSC), Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-4691-y"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2021.06.006"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061588"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2023.12.010"},{"key":"e_1_3_4_6_2","volume-title":"StatPearls Publishing Copyright \u00a9 2025, StatPearls Publishing LLC., Treasure Island (FL) ineligible companies. 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