Published May 19, 2023 | Version v1
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Case report: Analysis of phage therapy failure in a patient with a Pseudomonas aeruginosa prosthetic vascular graft infection

Authors/Creators

  • 1. Translational and Multidisciplinary Microbiology (MicroTM)-Biomedical Research Institute (INIBIC), University of A Coruña (UDC), A Coruña, Spain, Microbiology Service, A Coruña Hospital (HUAC), University of A Coruña (UDC), A Coruña, Spain
  • 2. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain, Departamentos de Medicina y Microbiología, Facultad de Medicina, Universidad de Sevilla, Seville, Spain, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Seville, Spain, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
  • 3. Unit of Infectious Diseases and Microbiology, Valme University Hospital, Institute of Biomedicine of Sevilla, Seville, Spain,
  • 4. Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Seville, Spain, Computational Systems Medicine, Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Sevilla, Seville, Spain
  • 5. Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Neder-over-Heembeek, Belgium

Description

Clinical case of a patient with a Pseudomonas aeruginosa multidrug-resistant
prosthetic vascular graft infection which was treated with a cocktail of phages
(PT07, 14/01, and PNM) in combination with ceftazidime-avibactam (CZA).
After the application of the phage treatment and in absence of antimicrobial
therapy, a new P. aeruginosa bloodstream infection (BSI) with a septic residual
limb metastasis occurred, now involving a wild-type strain being susceptible to
ß-lactams and quinolones. Clinical strains were analyzed by microbiology and
whole genome sequencing techniques. In relation with phage administration,
the clinical isolates of P. aeruginosa before phage therapy (HE2011471) and post
phage therapy (HE2105886) showed a clonal relationship but with important
genomic changes which could be involved in the resistance to this therapy. Finally,
phenotypic studies showed a decrease inMinimumInhibitory Concentration (MIC)
to ß-lactams and quinolones as well as an increase of the biofilm production and
phage resistant mutants in the clinical isolate of P. aeruginosa post phage therapy.

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Journal article: 37275366/PMID (Handle)