Successful Treatment of a Recalcitrant Staphylococcus epidermidis Prosthetic Knee Infection with Intraoperative Bacteriophage Therapy

Here, we present a case of a 79-year-old female with a recalcitrant Staphylococcal epidermidis prosthetic knee infection that was successfully treated with a single dose of adjuvant intra-articular bacteriophage therapy after debridement and implant retention surgery. The bacteriophage used in this case, PM448, is the first ɛ2 bacteriophage to be used in vivo. Currently the patient is without evidence of clinical recurrence and, interestingly, the patient had also suffered from debilitating aplastic anemia for over 2 years, which is recovering since receiving adjuvant bacteriophage therapy.

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Linezolid treatment of total prosthetic knee infection due to methicillin-resistant Staphylococcus epidermidis

Journal of Infection ◽

10.1016/s0163-4453(03)00019-7 ◽

2003 ◽

Vol 47 (1) ◽

pp. 87-88 ◽

Cited By ~ 13

Author(s):

A JOVERSAENZ

Keyword(s):

Staphylococcus Epidermidis ◽

Methicillin Resistant ◽

Knee Infection ◽

Prosthetic Knee ◽

Prosthetic Knee Infection

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Dalbavancin treatment of prosthetic knee infection due to oxacillin-resistant Staphylococcus epidermidis

Enfermedades infecciosas y microbiologia clinica (English ed ) ◽

10.1016/j.eimce.2017.04.013 ◽

2018 ◽

Vol 36 (2) ◽

pp. 142-143

Author(s):

María Ramírez Hidalgo ◽

Alfredo Jover-Sáenz ◽

Mercè García-González ◽

Fernando Barcenilla-Gaite

Keyword(s):

Staphylococcus Epidermidis ◽

Knee Infection ◽

Prosthetic Knee ◽

Prosthetic Knee Infection

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Arthroscopic “Debridement and Implant Retention” With Local Administration of Exebacase (Lysin CF-301) Followed by Suppressive Tedizolid as Salvage Therapy in Elderly Patients for Relapsing Multidrug-Resistant S. epidermidis Prosthetic Knee Infection

Frontiers in Medicine ◽

10.3389/fmed.2021.550853 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tristan Ferry ◽

Cécile Batailler ◽

Aubin Souche ◽

Cara Cassino ◽

Christian Chidiac ◽

...

Keyword(s):

Elderly Patients ◽

Salvage Therapy ◽

Clinical Signs ◽

Multidrug Resistant ◽

Sinus Tract ◽

Local Administration ◽

Loss Of Function ◽

Prosthetic Knee ◽

Implant Retention ◽

Prosthetic Knee Infection

Exebacase, a recombinantly produced lysin has recently (i) reported proof-of-concept data from a phase II study in S. aureus bacteremia and (ii) demonstrated antibiofilm activity in vitro against S. epidermidis. In patients with relapsing multidrug-resistant (MDR) S. epidermidis prosthetic knee infection (PKI), the only surgical option is prosthesis exchange. In elderly patients who have undergone several revisions, prosthesis explantation could be associated with definitive loss of function and mortality. In our BJI reference regional center, arthroscopic debridement and implant retention with local administration of exebacase (LysinDAIR) followed by suppressive tedizolid as salvage therapy is proposed for elderly patients with recurrent MDR S. epidermidis PKI with no therapeutic option or therapeutic dead end (for whom revision or transfemoral amputation is not feasible and no other oral option is available). Each use was decided in agreement with the French health authority and in accordance with the local ethics committee. A written consent was obtained for each patient. Exebacase (75 mg/mL; 30 mL) was administered directly into the joint during arthroscopy. Four patients (79–89 years old) were treated with the LysinDAIR procedure. All had several previous prosthetic knee revisions without prosthesis loosening. Three had relapsing PKI despite suppressive antibiotics following open DAIR. Two had clinical signs of septic arthritis; the two others had sinus tract. After the LysinDAIR procedure, no adverse events occurred during arthroscopy; all patients received daptomycin 8 mg/kg and linezolid 600 mg bid (4–6 weeks) as primary therapy, followed by tedizolid 200 mg/day as suppressive therapy. At 6 months, recurrence of the sinus tract occurred in the two patients with sinus tract at baseline. After >1 year follow up, the clinical outcome was favorable in the last two patients with total disappearance of clinical signs of septic arthritis even if microbiological persistence was detected in one of them. Exebacase has the potential to be used in patients with staphylococci PKI during arthroscopic DAIR as salvage therapy to improve the efficacy of suppressive antibiotics and to prevent major loss of function.

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Image-guided in situ detection of bacterial biofilms in a human prosthetic knee infection model: a feasibility study for clinical diagnosis of prosthetic joint infections

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-04982-w ◽

2020 ◽

Author(s):

Jorrit W. A. Schoenmakers ◽

Marjolein Heuker ◽

Marina López-Álvarez ◽

Wouter B. Nagengast ◽

Gooitzen M. van Dam ◽

...

Keyword(s):

Optical Imaging ◽

Bacterial Species ◽

Bacterial Biofilms ◽

Infection Model ◽

Knee Infection ◽

Prosthetic Knee ◽

Image Guided ◽

Prosthetic Joints ◽

Prosthetic Joint Infections ◽

Prosthetic Knee Infection

Abstract Purpose Due to an increased human life expectancy, the need to replace arthritic or dysfunctional joints by prosthetics is higher than ever before. Prosthetic joints are unfortunately inherently susceptible to bacterial infection accompanied by biofilm formation. Accurate and rapid diagnosis is vital to increase therapeutic success. Yet, established diagnostic modalities cannot directly detect bacterial biofilms on prostheses. Therefore, the present study was aimed at investigating whether arthroscopic optical imaging can accurately detect bacterial biofilms on prosthetic joints. Methods Here, we applied a conjugate of the antibiotic vancomycin and the near-infrared fluorophore IRDye800CW, in short vanco-800CW, in combination with arthroscopic optical imaging to target and visualize biofilms on infected prostheses. Results We show in a human post-mortem prosthetic knee infection model that a staphylococcal biofilm is accurately detected in real time and distinguished from sterile sections in high resolution. In addition, we demonstrate that biofilms associated with the clinically most relevant bacterial species can be detected using vanco-800CW. Conclusion The presented image-guided arthroscopic approach provides direct visual diagnostic information and facilitates immediate appropriate treatment selection.

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