Case Report: Arthroscopic "Debridement Antibiotics and Implant Retention" With Local Injection of Personalized Phage Therapy to Salvage a Relapsing Pseudomonas Aeruginosa Prosthetic Knee Infection.
Autor: | Ferry T; Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.; Université Claude Bernard Lyon 1, Lyon, France.; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France., Kolenda C; Université Claude Bernard Lyon 1, Lyon, France.; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.; Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France., Batailler C; Université Claude Bernard Lyon 1, Lyon, France.; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France., Gaillard R; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France., Gustave CA; Université Claude Bernard Lyon 1, Lyon, France.; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.; Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France., Lustig S; Université Claude Bernard Lyon 1, Lyon, France.; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France., Fevre C; Pherecydes Pharma, Romainville, France., Petitjean C; Pherecydes Pharma, Romainville, France., Leboucher G; Service de Pharmacie Hospitalière, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France., Laurent F; Université Claude Bernard Lyon 1, Lyon, France.; Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.; Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.; Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. |
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Jazyk: | angličtina |
Zdroj: | Frontiers in medicine [Front Med (Lausanne)] 2021 May 05; Vol. 8, pp. 569159. Date of Electronic Publication: 2021 May 05 (Print Publication: 2021). |
DOI: | 10.3389/fmed.2021.569159 |
Abstrakt: | Bacteriophages are viruses that specifically target bacteria. They are considered to have a high potential in patients with prosthetic joint infection (PJI), as they have a synergistic anti-biofilm activity with antibiotics. We report here the case of an 88-year-old man (63 kg) with relapsing Pseudomonas aeruginosa prosthetic knee infection. The patient had severe alteration of the general status and was bedridden with congestive heart failure. As prosthesis explantation and/or exchange was not feasible, we proposed to this patient the use of phage therapy to try to control the disease in accordance with the local ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). Three phages, targeting P. aeruginosa , were selected based on their lytic activity on the patient's strain (phagogram). Hospital pharmacist mixed extemporaneously the active phages (initial concentration 1 ml of 1 × 10 10 PFU/ml for each phage) to obtain a cocktail of phages in a suspension form (final dilution 1 × 10 9 PFU/ml for both phages). Conventional arthroscopy was performed and 30 cc of the magistral preparation was injected through the arthroscope (PhagoDAIR procedure). The patient received intravenous ceftazidime and then oral ciprofloxacin as suppressive antimicrobial therapy. Under this treatment, the patient rapidly improved with disappearance of signs of heart failure and pain of the left knee. During the follow-up of 1 year, the local status of the left knee was normal, and its motion and walking were unpainful. The present case suggests that the PhagoDAIR procedure by arthroscopy has the potential to be used as salvage therapy for patients with P. aeruginosa relapsing PJI, in combination with suppressive antimicrobial therapy. A Phase II clinical study deserves to be performed to confirm this hypothesis. Competing Interests: CF and CP are employed by Pherecydes Pharma. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Ferry, Kolenda, Batailler, Gaillard, Gustave, Lustig, Fevre, Petitjean, Leboucher, Laurent and the Lyon BJI Study group.) |
Databáze: | MEDLINE |
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