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噬菌体治疗对 12 岁肺移植囊性纤维化患者泛耐药 的一例报告。

A Case of Phage Therapy against Pandrug-Resistant in a 12-Year-Old Lung-Transplanted Cystic Fibrosis Patient.

机构信息

Université de Paris, F-75006 Paris, France.

Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

出版信息

Viruses. 2021 Jan 5;13(1):60. doi: 10.3390/v13010060.

Abstract

Bacteriophages are a promising therapeutic strategy among cystic fibrosis and lung-transplanted patients, considering the high frequency of colonization/infection caused by pandrug-resistant bacteria. However, little clinical data are available regarding the use of phages for infections with . A 12-year-old lung-transplanted cystic fibrosis patient received two rounds of phage therapy because of persistent lung infection with pandrug-resistant . Clinical tolerance was perfect, but initial bronchoalveolar lavage (BAL) still grew . The patient's respiratory condition slowly improved and oxygen therapy was stopped. Low-grade airway colonization by persisted for months before samples turned negative. No re-colonisation occurred more than two years after phage therapy was performed and imipenem treatment was stopped. Whole genome sequencing indicated that the eight isolates, collected during phage therapy, belonged to four delineated strains, whereby one had a stop mutation in a gene for a phage receptor. The dynamics of lung colonisation were documented by means of strain-specific qPCRs on different BALs. We report the first case of phage therapy for lung infection in a lung-transplanted patient. The dynamics of airway colonization was more complex than deduced from bacterial culture, involving phage susceptible as well as phage resistant strains.

摘要

噬菌体是囊性纤维化和肺移植患者有前途的治疗策略,因为多药耐药菌引起的定植/感染频率很高。然而,关于噬菌体用于感染的临床数据很少。一名 12 岁的肺移植囊性纤维化患者因持续的肺部多药耐药感染接受了两轮噬菌体治疗。临床耐受性完美,但最初的支气管肺泡灌洗(BAL)仍生长。患者的呼吸状况逐渐改善,停止了吸氧治疗。低水平的气道定植持续了数月,然后样本转为阴性。噬菌体治疗和亚胺培南治疗停止两年多后,没有再发生定植。全基因组测序表明,在噬菌体治疗期间收集的 8 个 分离株属于四个划定的菌株,其中一个噬菌体受体基因发生了停止突变。通过不同 BAL 上的菌株特异性 qPCR 记录了肺部定植的动态。我们报告了首例肺移植患者中噬菌体治疗 肺部感染的病例。气道定植的动态比从细菌培养中推断的要复杂,涉及噬菌体敏感和噬菌体耐药菌株。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c0a/7824836/756d4ac0a8c2/viruses-13-00060-g001.jpg

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