Case Report: Arthroscopic "Debridement Antibiotics and Implant Retention" With Local Injection of Personalized Phage Therapy to Salvage a Relapsing Pseudomonas Aeruginosa Prosthetic Knee Infection.
Case Report: Arthroscopic "Debridement Antibiotics and Implant Retention" With Local Injection of Personalized Phage Therapy to Salvage a Relapsing Pseudomonas Aeruginosa Prosthetic Knee Infection.
复制标题
DOI：
10.3389/fmed.2021.569159
复制
发表时间：
2021
影响因子：
3.9
通讯作者：
Lyon BJI Study group
中科院分区：
文献类型：
--
作者：
Ferry T;Kolenda C;Batailler C;Gaillard R;Gustave CA;Lustig S;Fevre C;Petitjean C;Leboucher G;Laurent F;Lyon BJI Study group
噬菌体是专门针对细菌的病毒。它们被认为在人工关节感染（PJI）患者中具有很高的潜力，因为它们与抗生素具有协同抗生物膜活性。我们在这里报告的情况下，88岁的男子（63公斤）与复发性铜绿假单胞菌人工膝关节感染。患者的一般状况发生严重变化，并因充血性心力衰竭而卧床不起。由于假体置换和/或更换不可行，我们建议该患者使用噬菌体治疗，以根据当地伦理委员会和法国国家药品和健康产品安全局（ANSM）控制疾病。基于它们对患者菌株的裂解活性（吞噬图），选择靶向铜绿假单胞菌的三种抗生素。医院药剂师临时混合活性噬菌体（每种噬菌体的初始浓度为1 ml，1 × 1010 PFU/ml），以获得悬浮液形式的噬菌体混合物（两种噬菌体的最终稀释度均为1 × 109 PFU/ml）。进行常规关节镜检查，并通过关节镜注射30 cc关节腔制剂（PhagoDAIR程序）。患者接受静脉注射头孢他啶，然后口服环丙沙星作为抑制性抗菌治疗。在这种治疗下，患者迅速改善，心力衰竭和左膝疼痛的体征消失。随访1年，左膝局部状态正常，活动和行走无疼痛。本病例表明，关节镜下的PhagoDAIR手术有可能与抑制性抗菌治疗联合用作铜绿假单胞菌复发性PJI患者的挽救治疗。值得进行II期临床研究以证实这一假设。
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 × 1010 PFU/ml for each phage) to obtain a cocktail of phages in a suspension form (final dilution 1 × 109 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.
登录
查看更多内容
影响因子：
3.9
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
通讯作者：
Laurent F
影响因子：
4.9
作者：
Kolenda, Camille;Josse, Jerome;Laurent, Frederic
通讯作者：
Laurent, Frederic
影响因子：
56.3
作者：
Jault, Patrick;Leclerc, Thomas;Gabard, Jerome
通讯作者：
Gabard, Jerome
影响因子：
14.2
作者：
Escudero-Sanchez, R.;Senneville, E.;Cobo, J.
通讯作者：
Cobo, J.
影响因子：
7.5
作者：
Pradier, M.;Robineau, O.;Senneville, Eric
通讯作者：
Senneville, Eric