Phage–Antibiotic Combination Therapy against Recurrent Pseudomonas Septicaemia in a Patient with an Arterial Stent

Abstract

<b>Background:</b> Intravascular stent infections are often associated with high risks of morbidity and mortality. We report here a case of a patient with an arterial stent and recurrent <i>Pseudomonas</i> septicaemias successfully treated with phage-meropenem combination therapy. <b>Methods:</b> A 75-year-old female with arteriosclerosis and comorbidities went through a femoropopliteal bypass with prosthesis in the right inguinal area. After the bypass, she developed a recurring <i>Pseudomonas aeruginosa</i> infection and also neutropenia during different antibiotics. A rapidly growing pseudoaneurysm in the right inguinal area led to an emergency intra-arterial stent placement during blood stream infection, later suspected to host a <i>P. aeruginosa</i> biofilm. Removing the stent was deemed precarious, and phage therapy was considered as a compassionate treatment option. A three-phage cocktail infecting the <i>P. aeruginosa</i> strain was prepared and administered intravenously together with meropenem for two weeks, after which, a ten-month follow-up was carried out. <b>Results:</b> No adverse reactions occurred during the phage therapy treatment, while infection markers were normalized. In addition, recovery was seen in a PET-CT scan. During the 10-month follow-up, no further <i>P. aeruginosa</i> septicaemias occurred. <b>Conclusions:</b> Phage-meropenem combination therapy was thus found safe and effective in the treatment of recurrent <i>Pseudomonas</i> septicaemia in a patient with an arterial stent.