The Role of Local Microbiological Monitoring and Phage Therapy in Counteracting Antimicrobial Resistance: An Analytical Review

Antimicrobial resistance (AMR) is a major medical and social threat since it reduces the clinical effectiveness of antimicrobial therapy, increases the risk of poor infectious disease outcomes, and requires coordinated action at the levels of health policy, laboratory services, and clinical practice. The aim of this review was to consider AMR control as an integrated system combining national policy, local microbiological monitoring, antimicrobial stewardship, and emerging anti-infective technologies, including phage therapy. A narrative analytical review of international and Russian guidelines, methodological papers, and scientific publications addressing AMR surveillance, local susceptibility data, cumulative antibiograms, clinically oriented monitoring, and bacteriophage-based treatment of infections caused by resistant Gram-negative pathogens was performed. The clinical value of local monitoring is determined not only by the volume of laboratory data but also by the quality of metadata, separation of diagnostic and screening isolates, deduplication of repeated cultures, expert assessment of results, as well as direct linkage between reports and local empirical treatment protocols. Phage therapy is considered a promising personalized and adjunctive approach for infections caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, particularly when standard antibacterial therapy has limited effectiveness. However, its broader implementation requires standardization of phage susceptibility testing, development of phage banks, regulatory solutions, quality control of preparations, and assessment of clinical efficacy in controlled studies. Integration of epidemiological surveillance, clinical microbiology, digital platforms, antimicrobial stewardship, and phage technologies may be considered a promising model for AMR containment in routine clinical practice.