Bacteriophage Therapy for Critical Infections Related to Cardiothoracic Surgery

Abstract

(1) Objective: Bacterial resistance to conventional antibiotic therapy is an increasingly significant worldwide challenge to human health. The objective is to evaluate whether bacteriophage therapy could complement or be a viable alternative to conventional antibiotic therapy in critical cases of bacterial infection related to cardiothoracic surgery. (2) Methods: Since September 2015, eight patients with multi-drug resistant or especially recalcitrant Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli infections were treated with bacteriophage preparations as a therapy of last resort according to Article 37 of the Declaration of Helsinki. Patients had infections associated with immunosuppression after organ transplantation or had infections of vascular grafts, implanted medical devices, and surgical wounds. Individualized phage preparations were administered locally, orally, or via inhalation for different durations depending on the case. All patients remained on conventional antibiotics during bacteriophage treatment. (3) Results: Patients ranged in age from 13 to 66 years old (average 48.5 ± 16.7) with seven males and one female. Eradication of target bacteria was reached in seven of eight patients. No severe adverse side effects were observed. (4) Conclusions: Phage therapy can effectively treat bacterial infections related to cardiothoracic surgery when conventional antibiotic therapy fails.

Progress and Pitfalls of Bacteriophage Therapy in Critical Care: A Concise Definitive Review

“…A 7-day course of IV and nebulized phages used adjunct to antibiotics was associated with “remarkable” clinical progress. Additional reports described infection resolution following adjunct PT for two ventilated patients with pneumonia, also due to MDR P. aeruginosa ( 31 ), and a patient with lung infection due to MDR Klebsiella pneumoniae ( 32 ). Case reports have also described instances, where antibiotics and adjunct PT failed to resolve respiratory infections.…”

“…Most, but not all of the recently published cases of compassionate use PT for bloodstream infections reported a favorable outcome with either notable improvement of the clinical condition or infection resolution ( 32 , 33 , 40 – 42 ). All patients were severely ill and underwent unsuccessful antibiotic treatment prior to the start of PT.…”

Bacteriophage Therapy for Clinical Biofilm Infections: Parameters That Influence Treatment Protocols and Current Treatment Approaches

“…The addition of bacteriophage therapy with debridement and irrigation surgeries is the other approach that has been used in several case studies [ 38 , 47 , 48 , 49 , 50 ]. This approach involves injection of high titers of bacteriophage phages directly at the site of the biofilm infection thereby circumventing hepatic clearance.…”

“…There have been several compassionate use case reports that have shown successful eradication of biofilm infections which include: chronic orthopedic hardware infections, LVAD infection, vascular graft infection, cardiothoracic surgery infections [ 38 , 47 , 48 , 49 , 50 ]. In these case reports different durations of bacteriophage therapy were used.…”

Editorial for the Special Issue: “Phage Therapy: A Biological Approach to Treatment of Bacterial Infections”

“…The last article of the Special Issue is a case report by Rubalskii et al, describing the phage therapy of eight patients having severe bacterial infections related to cardiothoracic surgery. The authors report the eradication of the pathogenic bacteria in seven out of eight patients for whom antibiotic treatments had earlier failed [ 9 ].…”