Reviewed by Erica Stohs, MD, MPH, University of Nebraska
Investigators obtained customized phage therapy through Food and Drug Administration-approved IND (investigational new drug) compassionate-care route to treat “difficult-to-treat” antimicrobial resistant infections. They report outcomes from 12 cases utilizing customized phage therapy for a variety of clinical infections (LVAD, prosthetic joint infection, UTIs, sternal wound infection with or without recurrent bacteremias).
Phages are viruses that infect bacteria, which can be adapted and customized to an individual’s causative bacterial isolate(s). To be considered for phage therapy, patients had to be chronically infected with a clonal pathogen that was multi-drug resistant and failed antibiotic treatment. Outcomes were categorized as favorable vs unfavorable based on clinical or microbiological criteria. All patients received concomitant antibiotic therapy. Phage therapy was administered intravenously over 5.6 weeks (mean), and one-third received phage therapy through an additional route (intraoperatively, intra-articular, or topically).
Of 50 requests, 12 patients received customized phage “cocktails.” Following therapy, 42% of cases showed bacterial eradication, 58% showed clinical improvement, and 66% were categorized as showing a favorable response. Investigators reported no major adverse reactions.
While phage therapy is not the holy grail of therapy for persistently infected individuals with MDROs, this study provides key considerations for future selecting and treating individuals with this novel approach.
Green SI, et al. “A retrospective, observational study of 12 cases of expanded-access customized phage therapy: production, characteristics, and clinical outcomes.” Clinical Infectious Diseases 2023;77(8):1079-91. https://doi.org/10.1093/cid/ciad3