Purpose
Bacteriophage therapy (BT) employs lytic bacteriophages to treat pathogenic bacteria.
Although BT is an emerging strategy against multidrug-resistant (MDR) infections,
experience in solid organ transplant is limited. We describe BT in four lung transplant
candidates and recipients with life-threatening MDR infections, including Pseudomonas aeruginosa (PsA) (n=3) and Burkholderia dolosa (n=1)
Methods
For each patient, lytic bacteriophages were selected against their bacterial isolates
(Table 1). Intravenous (IV) bacteriophage was administered for variable durations
under individual emergency Investigational New Drug applications and with patient
informed consent. Safety was assessed using clinical and laboratory parameters and
efficacy was based on clinical resolution of infection. All patients received concurrent
antibiotics.
Results
One lung transplant candidate and three recipients received BT. The transplant candidate
had developed acute kidney injury (AKI) on IV colistin for MDR PsA prompting adjunctive
BT administration. Following BT, colistin was discontinued, oxygen requirements improved,
AKI resolved, and she went on to lung transplant. Two ventilator dependent recipients
with refractory MDR PsA pneumonia despite antibiotic therapy and multiple pulmonary
procedures to mitigate airway complications also received BT therapy. Both patients
were weaned from mechanical ventilation prior to hospital discharge. A fourth patient
had recurrent B. dolosa infection following transplant despite IV antibiotic therapy. Following BT initiation
consolidative opacities improved and ventilator weaning was begun. There were no treatment-related
adverse events reported in the four cases.
Conclusion
BT was well-tolerated and was associated with clinical efficacy when used as an adjunct
to antibiotics in patients who were not responsive to antibiotics alone. Bacteriophage
therapy may be a viable adjunct to antibiotics in the era of increasing antimicrobial
resistance.
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Article info
Identification
Copyright
© 2019 Published by Elsevier Inc.
