Deploying bacteriophage combinatorial therapy to eradicate resistant Klebsiella pneumoniae UTIs: innovative and personalized phage therapy.

Klebsiella pneumoniae (K. pneumoniae) is a WHO priority pathogen, with multidrug-resistant (MDR) and carbapenem-resistant (CRKP) strains causing severe, often untreatable urinary tract infections (UTIs). The therapeutic impasse has reignited interest in bacteriophage (phage) therapy, a precision antibacterial approach that uses viruses to selectively lyse bacterial pathogens. The potential of phage therapy for MDR K. pneumoniae UTIs is critically evaluated in this review. We summarize the underlying biological rationale, concentrating on phage-mediated lysis and biofilm disruption. We then examine the translational landscape, comparing promising preclinical and compassionate-use data with the limited outcomes from early controlled clinical trials. A key theme is the critical need for strategic frameworks to guide clinical deployment, including rational cocktail design, phage-antibiotic synergy (PAS), and personalized approaches. Lastly, we list the main issues that must be addressed to incorporate phage therapy into the clinical arsenal against these powerful infections.