Researchers Use Phage Therapy and FMT to Reduce Recurrent UTIs in Patients

Novel Treatment Combines Phage Therapy and FMT for Recurrent UTIs

Recurrent urinary tract infections rank among the most common bacterial infections worldwide, predominantly affecting women. Defined as experiencing two infections within six months or three within the past year, rUTIs account for more than 15% of all outpatient antibiotic prescriptions. With rising antibiotic resistance limiting standard treatments, a team of researchers from Swiss and German institutions explored alternative therapeutic approaches.

Targeting Both Urinary and Intestinal Reservoirs

The experimental treatment was administered to three female patients between May and July 2023 at medicalxpress.com in Zurich, Switzerland, and Cologne University Hospital in Germany. All participants had microbiologically confirmed E. coli in multiple infections that had failed to respond to antibiotics and other commonly used non-antibiotic strategies.

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The patients received phage therapy both orally and intravesically—applied locally to the bladder via catheter—for eight days outside of acute episodes. Two of the three patients subsequently received elective fecal microbiota transplantation at Cologne University Hospital.

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Because the bacteria responsible for recurring infections reside in both the gut and the urinary tract, the FMT treatment specifically targeted intestinal E. coli reservoirs that often survive standard antibiotic treatments and grow increasingly resistant. While phage therapy acts to remove the pathogen, FMT aims to restore a healthy microbiome, combining both immediate and long-term effects, noted Dr. Lena Biehl, group leader at Fraunhofer ITMP, deputy lead of the Cologne Microbiota Bank, and scientist at technologynetworks.com.

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Clinical Outcomes and Patient Responses

The treatments were well tolerated and produced no noticeable side effects. Over a two-year follow-up period, the two patients who received the complete combination therapy experienced a long-term reduction in UTIs. The third patient, who received phage therapy only, experienced further infection episodes but with reduced symptoms.

Across all three patients, quality of life improved significantly, and the need for antibiotic treatment was substantially reduced, although E. coli was still detected in follow-up samples.

Path to a Comprehensive Clinical Trial

The project involved medical biologist Dr. Shawna McCallin and urologist Dr. Lorenz Leitner from Balgrist University Hospital; infectious disease researchers Dr. Lena Biehl and Dr. Annika Y. Classen from University Hospital Cologne; and Professor Dr. Maria Vehreschild from Goethe University Frankfurt, who serves as deputy coordinator for the German Center for Infection Research healthcare-associated infections research area.

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While the initial results are promising, researchers acknowledge the limitations of the small cohort. Three patients are not a sufficiently large sample to establish this new therapy, and control groups were lacking, McCallin stated according to Genengnews. However, this experience has helped to lay the foundation for a clinical trial in order to test the clinical utility of this treatment approach and make it more widely available and sustainable for patients.

The upcoming clinical trial is scheduled to begin in June 2027 at the participating institutions as part of the REPhRAME project, funded by the European Commission through the Horizon Europe funding programme.