Phage Therapy for the Treatment of Bacterial Infections in Heart and Lung Transplantation

Background: The increasing number of infections caused by multi- or even pan-resistant pathogens poses ever-greater problems for medicine. The development of new antibiotics has been neglected for years, while resistance has increased at the same time. This greatly complicates the management of patients requiring transplantation with chronic persistent and recalcitrant infections, as well as the prevention and treatment of bacterial infections in patients under drug induced immunosuppression after transplantation. Therapy with bacteriophages represents an innovative alternative or adjunct to the well-known antibiotics. Furthermore, the use of phages in the setting of a reduced T cell immune response may be an advantage in posttransplant patients.

Methods: In our clinic, five patients received phage therapy at various stages of heart or lung transplantation. Phage therapy was performed as an individualized cure attempt in case of clinically and microbiologically confirmed multidrug resistance of the target bacteria. The personalization of phage therapy was ensured by complete phenotypic and genetic characterization of the applied bacteriophage strains, as well as by using a phagogram.

Results: All five cases were successful and demonstrated three concepts for the use of bacteriophages in transplantation medicine. ¹One patient received bacteriophages for the treatment of exacerbated surgical site infection caused by multidrug-resistant bacterial flora (P. aeruginosa) previously detected in the preoperative period. (2) Three patients received phages for the treatment of nosocomial multidrug-resistant infections caused by K. pneumoniae, P. aeruginosa and S. aureus developed in the postoperative period. In all those four cases, a complete eradication of the pathogen from the focus was observed after phage therapy. (3) One patient received bacteriophages in the preoperative period before lung transplantation as supportive therapy of lung infection caused by a pan-resistant B. multivorans. The phage therapy made it possible to achieve stable control of the chronic infection and to carry out a successful lung transplantation.

Conclusion: Thus, personalized phage therapy can be recommended for several critical conditions in transplantation medicine in the absence of adequate conventional antibacterial therapy. Phages can be used to treat both community-acquired and healthcare-associated infections in heart and lung transplant patients and provide supportive therapy as a bridge to transplantation.

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Artikel online veröffentlicht:
13. Februar 2024