Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing S. aureus Prosthetic Knee Infection.
Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing S. aureus Prosthetic Knee Infection.
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DOI：
10.3389/fmed.2020.570572
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发表时间：
2020
影响因子：
3.9
通讯作者：
Laurent F
中科院分区：
文献类型：
--
作者：
Ferry T;Kolenda C;Batailler C;Gustave CA;Lustig S;Malatray M;Fevre C;Josse J;Petitjean C;Chidiac C;Leboucher G;Laurent F
目的：报告了3例连续复发性金黄色葡萄球菌人工膝关节感染（PKI）患者的治疗，这些患者在“清创抗生素和植入物保留”（DAIR）手术期间接受噬菌体治疗，随后接受抑制性抗菌治疗。方法：每个病例都在我们的参考中心和法国国家机构（ANSM）进行了单独讨论。三种酶对S.金黄色葡萄球菌是用受控和可再现的方法产生的，在手术前进行评估（吞噬图）。医院药剂师临时配制噬菌体混合物（每种噬菌体1 ml，1 × 1010 PFU/ml），作为“外分泌”制剂（最终稀释度1 × 109 PFU/ml），在DAIR程序和关节闭合（PhagoDAIR程序）后，由外科医生直接将其施用到关节中。结果：3例老年患者接受了PhagoDAIR手术。相位图显示对三种药物中的至少两种具有高敏感性。在手术过程中，所有患者的局部状况都很差，包括与植入物接触的脓液。经过长期随访，2例患者持续存在轻度滑液排出，随后进行DAIR，仅显示轻度滑液炎症，无细菌持续存在或双重感染。结果最终是有利的，功能得到了显著和令人印象深刻的临床改善。结论：PhagoDAIR手术有可能作为复发性S。金黄色葡萄球菌PKI，与抑制性抗生素组合，以避免相当大的功能损失。本报告提供了支持建立前瞻性多中心临床试验的初步数据。
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 × 1010 PFU/ml for each phage) as “magistral” preparation (final dilution 1 × 109 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.
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影响因子：
4.9
作者：
Kolenda, Camille;Josse, Jerome;Laurent, Frederic
通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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Lambotte, Jean Christophe