Phage Therapy in a Burn Patient Colonized with Extensively Drug-Resistant Pseudomonas aeruginosa Responsible for Relapsing Ventilator-Associated Pneumonia and Bacteriemia - PubMed


Cécile Teney 1 ,

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Phage Therapy in a Burn Patient Colonized with Extensively Drug-Resistant Pseudomonas aeruginosa Responsible for Relapsing Ventilator-Associated Pneumonia and Bacteriemia

Cécile Teney et al. Viruses. .

Abstract

Pseudomonas aeruginosa is one of the main causes of healthcare-associated infection in Europe that increases patient morbidity and mortality. Multi-resistant pathogens are a major public health issue in burn centers. Mortality increases when the initial antibiotic treatment is inappropriate, especially if the patient is infected with P. aeruginosa strains that are resistant to many antibiotics. Phage therapy is an emerging option to treat severe P. aeruginosa infections. It involves using natural viruses called bacteriophages, which have the ability to infect, replicate, and, theoretically, destroy the P. aeruginosa population in an infected patient. We report here the case of a severely burned patient who experienced relapsing ventilator-associated pneumonia associated with skin graft infection and bacteremia due to extensively drug-resistant P. aeruginosa. The patient was successfully treated with personalized nebulized and intravenous phage therapy in combination with immunostimulation (interferon-γ) and last-resort antimicrobial therapy (imipenem-relebactam).

Keywords: ICU; Pseudomonas aeruginosa; antimicrobial resistance; burns; phage therapy; ventilator-associated pneumonia.

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Conflict of interest statement

T.F. is the principal investigator of the Phaxiam therapeutics clinical trial PhagoDAIR I; Hospices Civils de Lyon received a research grant for the participation of T.F. in the Pherecydes board (later named Phaxiam). C.F. is an employee of Phaxiam therapeutics. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1

Sequential P. aeruginosa infections in relation to the human leucocyte antigen–DR isotype and timeline of immunostimulation, antimicrobial therapy, and phage therapy. IV: intravenous administration; VAP: ventilator-associated pneumonia; XDR: extensively drug-resistant. Pa02/Fi02: partial arterial pressure of oxygen (Pa02) over the fraction of inspired oxygen.

Figure 2
Figure 2

Imaging of the third episode of VAP due to XDR P. aeruginosa with (a) chest X-ray showing right apical opacities and computed tomography scan (CT scan) before the first phage therapy showing bilateral extensive diffuse pneumonia of the lungs; (b) chest X-ray at the end of the treatment showing improvement.

Figure 3
Figure 3

Phage administration scheme used to treat the patient, as adjuvant to imipenem-relebactam. The cocktail of active phages was administered daily intravenously and, at the same time, were also delivered locally by using a vibrating mesh nebulizer connected to the ventilator.

Figure 4
Figure 4

(a) Imaging chest X-ray and computed tomography scan of the last P. aeruginosa lung infection, showing new appeared posterior consolidations of the basal right lung before the administration of phage therapy (b) and at the end of the treatment, showing improvement in the posterior region of the right lung.

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References

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Access to phage therapy was facilitated by the PHAGE

in

LYON

Clinic

program supervised by T.F. and funded by Foundation Hospices Civils de Lyon (https://fondationhcl.fr).

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