Can phages salvage relapsing S. aureus knee replacements?
Three elderly patients with dead-end relapsing S. aureus prosthetic knee infection improved after DAIR plus an intra-articular three-phage cocktail and suppressive antibiotics.
Source
Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing <i>S. aureus</i> Prosthetic Knee Infection
Study at a glance
- Design
- Other — Three consecutive salvage case reports of PhagoDAIR (DAIR plus intra-articular S. aureus phage cocktail) plus suppressive antibiotics; no comparator arm.
- N
- N=3 · Three consecutive elderly patients with relapsing S. aureus prosthetic knee infection (ages 80, 84, 83).
- Population
- Elderly patients with relapsing S. aureus prosthetic knee infection in a therapeutic dead-end (revision not feasible) from the Lyon BJI cohort.
- Outcome
- Clinical infection control, function, and culture/PCR status after PhagoDAIR plus antibiotics and SAT.
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Can phages salvage relapsing S. aureus knee replacements?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
Three consecutive elderly patients received PhagoDAIR.
Three consecutive elderly patients were treated with the PhagoDAIR procedure.
Follow-up was 7, 11, and 30 months with favorable functional outcome.
After a follow-up of 7, 11, and 30 months, respectively, the outcome was favorable with a significant and impressive clinical improvement of the function for all patients
What they did
After ethics/ANSM review, they performed open DAIR, injected a magistral cocktail of lytic phages PP1493, PP1815, and PP1957 (1×10^9 PFU/ml) into the closed joint (PhagoDAIR), then gave 6–12 weeks of combination antibiotics followed by SAT.
What they found
All three had prior DAIR or one-stage exchange failure. After follow-up of 7, 11, and 30 months, function improved markedly. Two needed a later DAIR for mild synovial discharge with sterile cultures; one dual-strain patient kept a mild fistula. No superinfection was documented.
The limits
What it doesn't show
Uncontrolled n=3 salvage series cannot prove phages caused the improvement versus surgery and SAT; polyethylene could not be exchanged, two patients had extra DAIR, and a comparative trial is still needed.
Key terms
- PhagoDAIR
- Debridement, antibiotics, and implant retention plus intra-articular bacteriophage cocktail after joint closure.
- DAIR
- Surgical debridement with implant retention used when prosthesis exchange is not feasible.
- SAT
- Suppressive antimicrobial therapy continued after the intensive postoperative antibiotic course.
- Phagogram
- Lab tests (spot plaque and kinetic assays) of whether a patient’s S. aureus isolate is lysed by candidate phages.
- MOI
- Multiplicity of infection: the ratio of phage particles to bacterial cells in the phagogram assays.
- PJI / PKI
- Prosthetic-joint infection; here specifically prosthetic knee infection due to S. aureus biofilm.
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PhagoDAIR analytic n was:
Common questions
How many patients were treated?
Three consecutive elderly patients (80, 84, and 83 years old).
Which phages were used?
PP1493, PP1815, and PP1957, mixed to 1×10^9 PFU/ml and injected into the joint.
How long was follow-up?
7, 11, and 30 months, with improved walking in all three.
Did infection fully disappear in everyone?
Two became infection-sign free; patient 3 (two S. aureus strains) kept a mild intermittent fistula.
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