Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing S. aureus Prosthetic Knee Infection

Frontiers in Medicine

article

Tristan Ferry¹  Christian Chidiac¹  Gilles Leboucher⁵  Frédéric Laurent²  Camille Kolenda²  Cécile Batailler²  Claude-Alexandre Gustave²  Sébastien Lustig²  Matthieu Malatray³  Cindy Fevre⁷  Jérôme Josse²  Charlotte Petitjean⁷ 

[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;Service de Pharmacie Hospitalière, Hôpital de la Croix-Rousse;Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse;Pherecydes Pharma

关键词: bacteriophages;    phage therapy;    prosthetic-joint infection;    S;    aureus;    phagotherapy;   

DOI  :  10.3389/fmed.2020.570572

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objectives: To report the management of three consecutive patients with relapsing Staphylococcus aureus prosthetic knee infection (PKI) for whom explantation was not feasible who received a phage therapy during a “Debridement Antibiotics and Implant Retention” (DAIR) procedure followed by suppressive antimicrobial therapy. Methods: Each case was discussed individually in our reference center and with the French National Agency (ANSM). The lytic activity of three phages targeting S. aureus , which was produced with a controlled and reproducible process, was assessed before surgery (phagogram). A hospital pharmacist extemporaneously assembled the phage cocktail (1 ml of 1 × 10 10 PFU/ml for each phage) as “magistral” preparation (final dilution 1 × 10 9 PFU/ml), which was administered by the surgeon directly into the joint, after the DAIR procedure and joint closure (PhagoDAIR procedure). Results: Three elderly patients were treated with the PhagoDAIR procedure. Phagograms revealed a high susceptibility to at least two of the three phages. During surgery, all patients had poor local conditions including pus in contact to the implant. After a prolonged follow-up, mild discharge of synovial fluid persisted in two patients, for whom a subsequent DAIR was performed showing only mild synovial inflammation without bacterial persistence or super-infection. The outcome was finally favorable with a significant and impressive clinical improvement of the function. Conclusions: The PhagoDAIR procedure has the potential to be used as salvage for patients with relapsing S. aureus PKI, in combination with suppressive antibiotics to avoid considerable loss of function. This report provides preliminary data supporting the setup of a prospective multicentric clinical trial.

【 授权许可】

CC BY