Phage Therapy for Knee Prosthesis Infection

Bacteriophages show great potential in treating patients with prosthetic joint infections, as they act synergistically with antibiotics and destroy biofilms. The journal Frontiers in Medicine published a clinical case on the treatment of a recurrent prosthetic joint infection caused by Pseudomonas aeruginosa *

An 88-year-old male patient, weighing 63 kg, with a recurrent infection of the left knee prosthesis caused by Pseudomonas aeruginosa, experienced a significant deterioration of his general condition. He required bed rest due to congestive heart failure, and his C-reactive protein level was 100 mg/l. As neither removal nor replacement of the prosthesis was possible, the patient was offered phage therapy.

Three bacteriophages were selected for therapy due to their high lytic activity against the P. aeruginosa strain isolated from the patient. A clinical pharmacist extemporaneously prepared a phage cocktail in the form of a suspension (initial concentration 1 × 10^10 pfu/ml for each phage), which was diluted to a concentration of 1 × 10^9 pfu/ml for each phage before use.

The patient underwent arthroscopy, and 30 ml of the phage preparation was injected via the arthroscope (PhagoDAIR procedure). At the same time, the patient began antimicrobial therapy, which lasted 3 weeks: Ceftazidime intravenously (IV) 6 g/day and Ciprofloxacin 500 mg orally twice daily. During treatment, the patient’s condition rapidly improved, symptoms of congestive heart failure and knee pain disappeared, and C-reactive protein levels normalized. After 6 and 12 months, the condition of the left knee remained good, with pain-free movement and walking.

Thus, a combination of phage therapy (drug administration via an arthroscope) and antimicrobial therapy can potentially be used in the treatment of patients with prosthetic joint infections.

Source:
* Ferry T, Kolenda C, Batailler C, Gaillard R et al. Case Report: Arthroscopic “Debridement-Antibiotics and Implant Retention” with Local Injection of Personalized Phage Therapy to Salvage a Recurrent Pseudomonas Aeruginosa Knee Infection. Front Med (Lausanne) 2021, 8: 569159. doi: 10.3389 / fmed.2021.569159.