Successful treatment of a chronically infected and occluded aortobifemoral Dacron® bypass with bacteriophages (Snipha360)
Objectives: Graft infections are serious and feared complications in vascular surgery. Surgical resection of infected aortic grafts is associated with high mortality and morbidity. Therefore, alternatives to inadequate antibiotic treatment and extensive surgeries are indispensable.
Case: A 66-year-old patient was admitted with an infection of a chronically occluded aortobifemoral Dacron® prosthetic bypass. After various transfemoral surgical recanalization attempts, the patient’s history showed hostile tissue conditions on both femoral sides with chronic wound infection and exposed grafts. Local infection was confirmed by PET-CT imaging. Due to the patient’s comorbidities, only the isolated exposure of the prosthetic bypass was medically indicated and reasonable. Furthermore, we aimed to treat the bilateral femoral wound healing disorder. Bacteriophages were considered as an alternative therapy option for intra- and postoperative treatment of the graft-related soft tissue infection. After relaparotomy, the infected aortic prosthesis was excised, and the aorta was sutured. Bacteriophage suspension was dripped onto a Tabotamb-Snow®, which was then placed retroperitoneally. After discontinuation of the femoral anastomoses, a bacteriophage-soaked fleece was placed on the femoral side bilaterally, following the same principle. The wounds were mobilized and closed without further drainage. After a 10-day hospital stay, the patient was discharged with subjective well-being, irritation-free wound conditions, and no systemic inflammatory parameters. PET-CT imaging three months after the procedure showed no signs of infection around the aorta or both femoral regions.
Summary: This case demonstrates the supportive antibacterial effect of bacteriophages in septic aortic surgery and the successful secondary closure of chronically infected femoral wounds in high-risk patients.
Staphylococcus Aureus Sepsis; Graft Infection; Phage Therapy; Antibiotic Resistance
