Compassionate Use Case Studies

Patient #1 was a 68 year old male who developed a multidrug resistant Acinetobacter baumannii infected pancreatic pseudocyst. Despite multiple antibiotic courses, the patient deteriorated over a four month period and became comatose. Bacteriophage therapy was administered. A marked improvement in the patient’s condition was observed within 48 hours of starting intravenous therapy. Following 11 weeks of therapy, the patient made a full recovery. This case was published in the journal Antimicrobial Agents and Chemotherapy as “Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails to Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection” (Schooley 2017).

Patient #2 was a 2 year old male with a history of DiGeorge Syndrome and complex congenital heart disease. Following cardiac surgery, he developed a recalcitrant multidrug resistant Pseudomonas aeruginosa bacteremia. Bacteriophage therapy was initiated intravenously, but then held due to progressive heart failure. Despite premature cessation of therapy, blood cultures obtained 4 and 5 days subsequently were sterile. Therapy was resumed 11 days after cessation, and blood cultures that had become positive reverted back to sterile. Unfortunately, the patient decompensated, presumably due to progression of undrained fluid collections, antecedent influenza infection, and end-stage cardiac failure. This case was published in the Journal of Pediatric Infectious Diseases Society as “Refractory Pseudomonas Bacteremia in a 2-Year-Old Sterilized by Bacteriophage Therapy” (Duplessis 2017).

Patient #3 was a 77 year old male who suffered a traumatic brain injury. He developed a craniectomy site infection with multidrug resistant Acinetobacter baumannii. Intravenous  bacteriophage therapy was administered for 8 days. The patient initially seemed more alert, but fever and leukocytosis persisted. The craniectomy site and skin flap healed well. Before receipt of the second phage cocktail, the patient’s family decided to withdraw care, and the patient died. This was published in the journal Open Forum Infectious Diseases as “Phage Therapy for a Multidrug-Resistant Acinetobacter baumannii Craniectomy Site Infection” (LaVergne 2018).

Patient #4 was a 67 year old male with a history of hypersensitivity pneumonitis and pulmonary fibrosis. He underwent bilateral lung transplantation in October 2016. His post-transplant course was complicated, including the development of two episodes of multidrug resistant Pseudomonas aeruginosa pneumonia. Bacteriophage therapy was administered via nebulizer and intravenously, along with adjunctive systemic antibiotics. Therapy was well tolerated without any attributable adverse events. Both episodes of pneumonia resolved, and the patient’s respiratory status improved. Patient was discharged from the hospital infection-free. This case is in the process of being submitted for publication to the Journal of Heart and Lung Transplantation as “Bacteriophage Therapy as an Adjunct to Systemic Antibiotics for Treatment of Multidrug Resistant Pseudomonas aeruginosa Pneumonia in a Lung Transplant Recipient” (Aslam 2018).

Patient #5 was a 25 year old female with cystic fibrosis. She had a long history of multidrug resistant Burkholderia cenocepacia in her sputum. Despite her history, she was able to find a surgeon willing to perform a double lung transplant. Her post-transplant course was complicated by a re-emergence of the multidrug resistant Burkholderia cenocepacia in her blood, pneumonia and deteriorating respiratory status. The patient received two doses of intravenous bacteriophage therapy. She continued to decompensate over the next few hours and passed away due to progressive respiratory failure.

Patient #6 was a 60 year old male with a left ventricular assist device infected with multidrug resistant Pseudomonas aeruginosa. His blood cultures were positive. He received 6 weeks of an intravenous bacteriophage mixture containing three phage. Phage was provided to the patient in four shipments. Drainage from the device became significantly less, and the patient eventually became culture negative. This case was a pioneer for the use of outpatient intravenous phage in the home without sequelae.

Patient #7 was a 41 year old male who sustained multiple traumas including the left knee. He developed a post-operative wound infection with multidrug resistant Klebsiella pneumoniae and Acinetobacter baumannii. A second muscle flap surgery was performed in a final attempt to save the patient’s leg. Following surgery, the patient received a two week course of intravenous bacteriophage therapy. His wound drainage became culture negative, and the muscle flap healed completely. He was discharged from the hospital and avoided above knee amputation.