Abstract
Aim
Many bone and joint infections, in spite of appropriated antibiotics therapy and surgery, lead to a therapeutic dead end. We are then faced with a chronic infection with or without continuous antibiotic treatment, with daily local care, and an exhorbitant economic and social cost. Pami the incriminated factors: the presence of foreign implant material, the poor diffusion of antibiotics at the infectious site, the presence of biofilm.
The bacteriophages, biological drug, natural environmental viruses possess the properties to meet these difficulties: well diffusion to the infectious focus with possibilities of local use, destruction of the biofilm allowing a release of the bacteria and a synergistic effect with the antibiotics, antibiofilm effect for the restoration of osteoblastosis.
Method and results
We report a cohort of phage - treated patients with or without antibiotics in bone and joint infections in a therapeutic dead end. Without disponibility of therapeutic phages available in the European Union, commercial cocktails of phages, antistaphylococcal or polyvalent, of Russian* or Georgian** origin were used.
Ten patients have benefited since 2008 from phages, alone or in combination with an adapted antibiotic therapy. Patients were 40 to 89 years old and had chronic bone and joint infections except for one case with acute MRSA infection on femoral implant. Bacteria were Staphylococcus aureus 7 times, Pseudomonas aeruginosa 3 times, Klebsiella 2 times. In 4 cases implant was left in place (knee prosthesis, femoral screw plate) or introduced (1 screw in 1 case) during the procedure. In all cases except 1 patient, the phages were applied in per-operative.
With a follow-up of up to 9 years for some patients, the initial bacteria were eradicated and in 2 cases replaced by another bacterium (Pseudomonas in place of S. aureus in one case and Enterococcus in place of P. aeruginosa for an elderly patient with a knee prosthesis without possible surgery.
Conclusion
The combination of surgery, phages and antibiotics appear a very efficient option, to treat patients with bone and joint infections in therapeutic dead end. The quick availability of these treatments for these patients is a health emergency.
*Microgen® Pharma
**Eliava Institute
