The Potential Innovative Use of Bacteriophages Within the DAC ® Hydrogel to Treat Patients With Knee Megaprosthesis Infection Requiring “Debridement Antibiotics and Implant Retention” and Soft Tissue Coverage as Salvage Therapy

Frontiers in Medicine

article

Tristan Ferry¹  Frédéric Laurent²  Sébastien Lustig²  Cécile Batailler²  Charlotte Petitjean⁶  Joseph Chateau¹  Cindy Fevre⁶  Emmanuel Forestier⁷  Sophie Brosset¹  Gilles Leboucher¹  Camille Kolenda² 

[1] Hôpital de la Croix-Rousse;Université Claude Bernard Lyon 1;Centre Interrégional de Référence pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon);CIRI—Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1;Institut des Agents Infectieux, Laboratoire de Bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse;Pherecydes Pharma;Centre Hospitalier Metropole Savoie

关键词: prosthetic joint infection;    bacteriophage;    phage therapy;    hydrogel;    megaprosthesis;   

DOI  :  10.3389/fmed.2020.00342

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Infection is the most dramatic complication in patients with knee megaprosthesis. Its management is more complex in comparison with patients with primary arthroplasty, with a high risk of relapse. Lytic bacteriophages are considered to have a high potential in patients with prosthetic joint infection as it has been demonstrated that they have a synergistic anti-biofilm activity with antibiotics. The Defensive Antibacterial Coating (DAC®) hydrogel is a hydrogel available in the market that has been designed to prevent the adherence of bacteria on a prosthetic joint and to have the ability to transport and release anti-bacterial substances such as antibiotics. We report here the case of a patient with a catastrophic relapsing Staphylococcus aureus knee megaprosthesis infection without prosthesis loosening. We firstly perform phage susceptibility testing of the patient's strain to select an active cocktail, under the supervision of the French health authority. Then, we performed, as salvage therapy, a debridement and implant retention procedure with application of a selected cocktail of bacteriophages that was prepared extemporaneously within the DAC® hydrogel. A free flap for soft tissue coverage was required and empirical antibiotic treatment was started immediately after the surgery. Unfortunately, at 5 days after the surgery, while the local aspect of the surgical site was favorable, the patient developed myocardial infarction which required emergency stenting and dual antiplatelet therapy that were rapidly associated with bleeding at the surgical site, leading to a new prosthesis exposition. As a consequence, a transfemoral amputation was finally performed several months later. We also evaluated in vitro the impact of DAC® hydrogel on bacteriophage activity and showed that the selected phages were released very rapidly from the DAC® hydrogel, and then their titers were stable for at least 6 h. This case demonstrated the feasibility of the use of bacteriophages within a hydrogel to treat patients for knee megaprosthesis infection during a debridement procedure. The implementation requires identification of the pathogen before the debridement in order to perform phage susceptibility testing of the patient's strain and to identify a hospital pharmacist who will accept to do the preparation and to take the responsibility of the magistral preparation.

【 授权许可】

CC BY