Table 2 Management details, results, and outcomes
NO. | Author | mono or cocktail BT | BT used | Route of BT administration | Follow up | BT related complications | Results and outcomes | |
|---|---|---|---|---|---|---|---|---|
1 | Ferry et al | cocktail | PhagoDAIR: A mixture of P aeruginosa and the S aureus phages was used. Three Phages (1493, 1815, and 1957) + SAT | IA | 18 months | None | The authors reported that the patient developed acute hematogenous Citrobacter koseri hip infection, managed by a new DAIR procedure (intraoperative samples did not grow S aureus). By the last follow up, the outcome was favorable without any clinical signs of persistent infection | |
2 | Doub et al. | monophage | phage SaGR51Φ1 + SAT | IA (with each debridement and with final prosthesis implantation) + IV for 3 days | NR | Transaminitis related to IV phage therapy administration which was reversible and non-life-threatening. No complications of repeated IA administration. | Satisfactory outcomes, limb salvage instead of amputation, reimplantation of a Megaprostheses. | |
3 | Ferry et al. | cocktail | phages PP1493 and PP1815 | IA (Phage within DAC hydrogel) | 12 months | None | Although phage therapy was used as a salvage procedure as the patient refused transfemoral amputation, The authors reported that the surgery failed due to bleeding and hematoma formation after receiving antiplatelet therapy (to treat myocardial infarction) with subsequent exposure of the free flap and re-infection; however, a bacterial culture of the hematoma revealed superinfection with Pseudomonas aeruginosa, Achromobacter spp., and Proteus mirabilis in culture. No S. aureus grew in culture (which was the target of the phage therapy) | |
4 | Ferry et al. (series of 3 cases) | 1 | cocktail | PhagoDAIR (PP1493, PP1815, and PP1957) + SAT | IA | 30 months | None | The patient had a serous discharge at 3 months which required a new DAIR procedure that showed non-specific synovitis and no infection recurrence. By the last follow up, the patient had a satisfactory outcome, limb and implant salvage, no recurrence or superinfection |
2 | cocktail | PhagoDAIR | IA | 7 months | None | Satisfactory outcomes, limb and implant salvage, no signs of infection, and pain-free walking. | ||
3 | cocktail | PhagoDAIR | IA | 11 months | None | Persistent discharge at 4 months required new DAIR procedures; cultures obtained during the procedure revealed no infection. By the last follow up, the patient had pain-free walking and no recurrence of infection. | ||
5 | Tkhilaishivili et al | monophage | bacteriophage therapy against MDR P. aeruginosa (no specific therapy was mentioned) + SAT | During the 1st stage of surgery(debridement and cement spacer), phage therapy was administered IA, followed postoperatively by IA infusion through drain tubes | 10 months | None | After 2 weeks of the 1st stage of surgery, the patient experienced purulent discharge, upon which the authors decided to perform another session of debridement and change the spacer; the sample obtained during this surgery showed methicillin-resistant Staphylococcus epidermidis growth (treated with antibiotics) but no P. aeruginosa (which was the target of phage therapy). By the last follow up, the patient had satisfactory outcomes, no knee pain, functional range of motion, no loosening, and no infection recurrence. | |
6 | Cano et al. | monophage | phage KpJH46Φ2 + SAT | IV (40 doses, each dose was taken on a weekday) | 8.5 months | None | Satisfactory outcomes, limb salvage instead of amputation option, no recurrence of infection, implants were retained. | |
7 | Doub et al | monophage | DAIR+ phage PM448 + SAT | IA + IV | 5 months | A transient increase in aspartate aminotransferase (AST) and alanine aminotransferase (ALT), upon which the IV therapy was stopped owing to patient concerns and requests. | The patient was sent home after five days of the procedure. Satisfactory outcomes, limb salvage, implants were retained, and full knee function. (The authors reported that the patient was suffering from aplastic anemia, which was improved after phage therapy) | |
8 | Ferry et al | cocktail | Arthroscopic debridement and the local application of phages, Three phages: PP1450, PP1777, and PP1792. + SAT | IA | 12 months | None | By the last follow up, the knee joint was normal with painless motion and walking. No infection recurrence. | |
9 | Neuts et al | cocktail | phages: Pyophage and IntestiPhage +SAT | oral suspension (for 19 days as a start, then a 2-week pause, followed by another 19 days of therapy). | 36 months | None | Limb salvage after the patient refused the Girdlestone option, a favorable outcome, no hip complaints, no infection recurrence. | |
10 | Ramirez-Sanchez et al | Cocktail | Three phages were used for the first treatment cycle: J-Sa36, Sa83, and Sa87. + SAT For the second treatment cycle, a single phage was used: SaGR51ø1. + SAT | For both treatment cycles, phage therapy was administered IA + IV (1st cycle was IA injection followed by IV therapy for 2 weeks) (2nd cycle was IA during the first stage of 2 stages revision) | 14 months (Calculated from the 2nd treatment cycle) | None | The patient developed a recurrent infection after the 1st cycle of management, upon which she underwent two stages revision, during which she received the 2nd cycle of management. Satisfactory outcomes, limb salvage after the patient refused the above knee amputation option, no recurrence of infection, and samples from the synovial fluid showed no bacterial growth till the last follow up. | |
11 | Schoeffel et al. knee and hip joints | monophage | Phage SaWIQ0488ø1 + SAT | IA + IV (Phage therapy was administered twice, the first was during debridement sessions for both hip and knee joints and after inserting a temporary spacer, where the patient received both IA and IV, and the second was during the implantation of the final prosthesis, during which the authors mentioned that the patient received only IA phages therapy) | 11 months | A slight transaminitis did not lead to phage therapy holding and returned to normal levels after treatment stoppage. | Satisfactory outcomes, samples obtained during the final implantation of the prosthesis for both hip and knee joints revealed no bacterial growth; the patient is ambulating without a cane, able to climb stairs, and driving. No recurrence of infection. | |