Journal
VIRUSES-BASEL
Volume 13, Issue 10, Pages -Publisher
MDPI
DOI: 10.3390/v13101898
Keywords
phage therapy; bacteriophage; Staphylococcus aureus; chronic osteitis; polymicrobial biofilm; antibiotic-bacteriophage combination; phage-antibiotic interactions; phage-antibiotic synergy
Categories
Funding
- Fonds de la Recherche Scientifique-FNRS [FC 36489]
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Phage therapy shows potential in managing biofilm infections, but may have limitations in polymicrobial infections. Combination of surgery and antibiotic therapy has a positive impact on improving these infections, but does not completely prevent recurrence.
Phage therapy (PT) shows promising potential in managing biofilm infections, which include refractory orthopedic infections. We report the case of a 13-year-old girl who developed chronic polymicrobial biofilm infection of a pelvic bone allograft after Ewing's sarcoma resection surgery. Chronic infection by Clostridium hathewayi, Proteus mirabilis and Finegoldia magna was worsened by methicillin-susceptible Staphylococcus aureus exhibiting an inducible Macrolides-Lincosamides-Streptogramin B resistance phenotype (iMLSB). After failure of conventional conservative treatment, combination of in situ anti-S. aureus PT with surgical debridement and intravenous antibiotic therapy led to marked clinical and microbiological improvement, yet failed to prevent a recurrence of infection on the midterm. This eventually led to surgical graft replacement. Multiple factors can explain this midterm failure, among which incomplete coverage of the polymicrobial infection by PT. Indeed, no phage therapy against C. hathewayi, P. mirabilis or F. magna could be administered. Phage-antibiotic interactions were investigated using OmniLog technology. Our results suggest that phage-antibiotic interactions should not be considered unconditionally synergistic , and should be assessed on a case-by-case basis. Specific pharmacodynamics of phages and antibiotics might explain these differences. More than two years after final graft replacement, the patient remains cured of her sarcoma and no further infections occurred.
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