Use of Customized Bacteriophages in the Treatment of Chronic Nonhealing Wounds: A Prospective Study
Use of Customized Bacteriophages in the Treatment of Chronic Nonhealing Wounds: A Prospective Study
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DOI：
10.1177/1534734619881076
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发表时间：
2019-11-22
影响因子：
1.7
通讯作者：
Nath, Gopal
中科院分区：
文献类型：
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作者：
Patel, Dev Raj;Bhartiya, Satyanam K.;Nath, Gopal
不愈合的溃疡对外科医生来说是一个巨大的挑战，因为它们偶尔会导致受影响部位的截肢。大多数伤口不愈合的结果是由于耐药性细菌的感染和随后的生物膜形成。然而，定制的噬菌体疗法可以解决上述两个障碍。本探索性前瞻性研究共纳入了48例年龄组为12 - 70岁的研究受试者，这些受试者至少有一处合格的全层伤口，并且在6周内接受常规治疗未能愈合。排除了全身性疾病患者，即烧伤、恶性肿瘤、皮肤病和麻风或结核溃疡。然而，本研究纳入了患有糖尿病和高血压的受试者。将用于单一细菌感染的定制的单噬菌体和对2种或更多种感染细菌特异性的噬菌体的混合物隔日施加在伤口表面上。总共施用5至7次，直到伤口没有感染细菌。研究期从2018年8月延长至2019年5月。研究受试者自治疗开始后随访3个月。治愈率为81.2%，其中非糖尿病患者占90.5%（19/21），糖尿病患者占74.1%（20/27）。观察到感染肺炎克雷伯氏菌的伤口愈合相对延迟。噬菌体治疗后，平均血红蛋白水平和淋巴细胞百分比显著增加。定制的局部噬菌体治疗在不愈合性溃疡中是非常有前途的。
Nonhealing ulcers are a great challenge to surgeons as they may occasionally culminate in amputation of the affected part. Mostly nonhealing of wounds results due to infection by antibiotic-resistant bacteria and subsequent biofilm formation. However, customized bacteriophage therapy may take care of both of the above-mentioned hurdles. A total of 48 study subjects of age group 12 to 70 years, having minimum one eligible full-thickness wound and failed to heal in 6-week duration with conventional therapy, were included in this exploratory prospective study. Patients with systemic diseases, that is, burn, malignancy, dermatological disorders, and ulcers with leprosy or tuberculosis, were excluded. However, subjects having diabetes and hypertension were included in the study. The customized monophage for single bacterial infection and cocktail of phages specific to 2 or more infecting bacteria were applied on an alternate day over the wound surface. A total of 5 to 7 applications were made till the wound became free of infecting bacteria. The study period extended from August 2018 to May 2019. The study subjects were followed for 3 months since the start of therapy. A cure rate of 81.2% could be obtained, of which 90.5% (19/21) patients were nondiabetic and 74.1% (20/27) diabetic. The wounds infected with Klebsiella pneumoniae were observed with relatively delayed healing. Post phage therapy, the mean hemoglobin level and percentage of lymphocytes increased significantly. The customized local phage therapy is very promising in nonhealing ulcers.