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Open AccessArticle

Bacteriophage Application for Difficult-To-Treat Musculoskeletal Infections: Development of a Standardized Multidisciplinary Treatment Protocol

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Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
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Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
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Centre for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium
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Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
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Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Brussels, Belgium
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Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
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Pharmacy Department, University Hospitals Leuven, 3000 Leuven, Belgium
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Department of General Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
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Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
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Department of Intensive Care Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
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Laboratory of Gene Technology, KU Leuven, 3001 Leuven, Belgium
*
Author to whom correspondence should be addressed.
Viruses 2019, 11(10), 891; https://doi.org/10.3390/v11100891
Received: 24 August 2019 / Revised: 17 September 2019 / Accepted: 19 September 2019 / Published: 23 September 2019
(This article belongs to the Section Bacterial Viruses)
Bacteriophage therapy has recently attracted increased interest, particularly in difficult-to-treat infections. Although it is not a novel concept, standardized treatment guidelines are currently lacking. We present the first steps towards the establishment of a “multidisciplinary phage task force” (MPTF) and a standardized treatment pathway, based on our experience of four patients with severe musculoskeletal infections. After review of their medical history and current clinical status, a multidisciplinary team found four patients with musculoskeletal infections eligible for bacteriophage therapy within the scope of Article 37 of the Declaration of Helsinki. Treatment protocols were set up in collaboration with phage scientists and specialists. Based on the isolated pathogens, phage cocktails were selected and applied intraoperatively. A draining system allowed postoperative administration for a maximum of 10 days, 3 times per day. All patients received concomitant antibiotics and their clinical status was followed daily during phage therapy. No severe side-effects related to the phage application protocol were noted. After a single course of phage therapy with concomitant antibiotics, no recurrence of infection with the causative strains occurred, with follow-up periods ranging from 8 to 16 months. This study presents the successful outcome of bacteriophage therapy using a standardized treatment pathway for patients with severe musculoskeletal infection. A multidisciplinary team approach in the form of an MPTF is paramount in this process. View Full-Text
Keywords: bacteriophage therapy; antibiotic resistance; multidisciplinary team; musculoskeletal infection bacteriophage therapy; antibiotic resistance; multidisciplinary team; musculoskeletal infection
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Onsea, J.; Soentjens, P.; Djebara, S.; Merabishvili, M.; Depypere, M.; Spriet, I.; De Munter, P.; Debaveye, Y.; Nijs, S.; Vanderschot, P.; Wagemans, J.; Pirnay, J.-P.; Lavigne, R.; Metsemakers, W.-J. Bacteriophage Application for Difficult-To-Treat Musculoskeletal Infections: Development of a Standardized Multidisciplinary Treatment Protocol. Viruses 2019, 11, 891.

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