Treatment adherence
Can phages salvage relapsing S. aureus knee replacements?
Open access · cc by · source: Europe PMC
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.
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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Key findings
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.
Methodology
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.
Limitations
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.
How this study connects
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