A bacteriophage therapy created the necessary conditions for successful antibiotic suppression in a periprosthetic hip joint infection: a case report

Peter Wahl^1,2Michel Schläppi¹Archana Loganathan³Ilker Uçkay⁴Sandro Hodel⁵Benjamin Fritz⁶Jens Scheidegger³Sarah Djebara⁷Lorenz Leitner^3*Shawna Mccallin^3*

• ¹Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Zürich, Switzerland
• ²Medizinische Fakultät, Universität Bern, Bern, Bern, Switzerland
• ³Department of Neuro-Urology, Balgrist University Hospital, Zurich, Switzerland
• ⁴Unit of Clinical and Applied Research and Department of Infectiology, Balgrist University Hospital, Zurich, Switzerland
• ⁵Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
• ⁶Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
• ⁷Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels, Belgium

Introduction: Treatment failure remains an issue in periprosthetic joint infection (PJI).Bacteriophages offer new treatment options. However, there is still a lack of evidence to better define their usefulness and administration. We report a case in which antibiotic suppression was successful only after administration of bacteriophages.Case description: Antibiotic suppression was the only option for a 94-year-old male with methicillin-resistant Staphylococcus aureus (MRSA) PJI of the hip and of the knee. As the hip PJI could not be suppressed adequately, bacteriophages were administered locally and systemically together with daptomycin. This combined approach led to sufficient clinical improvement for further oral antibiotic suppression, although without infection eradication.Conclusions: The administration of bacteriophages may be a valuable, less-invasive adjunct therapy to successfully suppress PJI. Bacteriophage selection, preparation and administration, however, remains associated with administrative obstacles, greatly limiting availability and practicability. Nevertheless, research and developments in this domain should be pursued, particularly considering issues with future antibiotic limitations and cost associated with treatment failure in PJI.