A patient with a left tibia infection caused by an extremely resistant strain of Acinetobacter baumannii and a multidrug-resistant strain of Klebsiella pneumoniae was treated with a combination of specific bacteriophages and antibiotics. Rapid eradication of the bacteria and wound healing prevented amputation.

A clinical case of phage therapy for bacterial osteomyelitis was described by Israeli doctors in the journal Clinical Infectious Disease*.

Osteomyelitis developed following a lower extremity injury sustained in a traffic accident. The patient was treated for an open fracture of the tibia. After six weeks of treatment, an extremely resistant (XDR) strain of A. baumannii and a multidrug-resistant strain of K. pneumoniae were isolated from the wound. Long courses of antibiotic therapy (6 weeks of piperacillin/tazobactam, then 8 weeks of meropenem and high-dose colistin) were ineffective. Due to the severe condition of the limb, amputation was recommended.

The patient consented to phage therapy. He received a combination of phages active against A. baumannii (phage ɸAbKT21phi3) and K. pneumoniae (phage ɸKpKT21phi1), along with meropenem and colistin. The initial course lasted 5 days, with 1 ml of each phage solution (5 x 107 PFU/ml) applied topically three times daily for 35 minutes. No side effects were recorded from phage therapy.

After the first course of phage therapy, A. baumannii was isolated from the wound, so a week later the patient underwent a second six-day course of phage therapy.

Within a few days of starting phage therapy, the first signs of wound healing were noticeable, and the pain subsided. By the end of the second course of phage therapy, the wound had closed, no exudate was released, and the pain had disappeared. No pathogenic bacteria were isolated during the eight-month follow-up period.

Thus, the use of specific bacteriophages in the treatment of antibiotic-resistant infections made it possible to prevent limb amputation and ensure full rehabilitation.

* Nir-Paz R, Gelman D, Khouri A et al. Successful treatment of antibiotic resistant poly-microbial bone infection with bacteriophages and antibiotics combination // Clinical Infectious Diseases, Published: 14 March 2019, ciz222. https://doi.org/10.1093/cid/ciz222