Gainey Andrew B, Daniels Robert, Burch Anna-Kathryn, Hawn Jason, Fackler Joseph, Biswas Biswajit, Brownstein Michael J
From the Department of Pharmacy, Division of Pediatric Infectious Diseases, Prisma Health Children's Hospital-Midlands, Columbia, South Carolina.
Department of Pediatrics, Division of Pediatric Infectious Diseases, Prisma Health Children's Hospital-Midlands, Columbia, South Carolina.
Pediatr Infect Dis J. 2023 Jan 1;42(1):43-46. doi: 10.1097/INF.0000000000003735. Epub 2022 Oct 6.
Treating recurrent multidrug resistant (MDR) urosepsis in pediatric transplant recipients can be challenging. Particularly when antibiotics fail to prevent future occurrence and the nidus is seemingly undiscoverable. While there is an increasing amount of data on phage therapy, to our knowledge, there are no published cases involving pediatric renal transplant recipients. Therefore, we present a challenging clinical case in which phage therapy was used in a pediatric renal transplant recipient who developed recurrent MDR urosepsis with an unclear source.
Our patient was a 17-year-old female who initially developed urosepsis caused by extended-spectrum β-lactamase (ESBL) Escherichia coli , while being treated with an immunosuppressant regimen because of kidney rejection secondary to poor immunosuppression therapy compliance. She was admitted to our hospital intermittently for 4 months with 4 episodes of urosepsis caused by ESBL E. coli . She received multiple courses of antibiotics (mainly ertapenem) and underwent a fecal material transplant to eradicate her ESBL E. coli colonized gastrointestinal tract. Because of recurrent development of urosepsis after antibiotic treatment, she later underwent treatment with a phage cocktail consisting of 2 isolate-specific phages. After a prolonged antibiotic course and subsequent 3-week intravenous phage treatment, she had no ESBL E. coli in her urinary cultures for 4 years post-treatment.
This case highlights the challenges of treating recurrent ESBL E. coli infections in a pediatric renal transplant patient and provides evidence that phage therapy may prove useful in such cases.
治疗小儿移植受者复发性多重耐药（MDR）泌尿道感染可能具有挑战性。特别是当抗生素无法预防未来感染的发生且感染病灶似乎难以发现时。虽然关于噬菌体疗法的数据越来越多，但据我们所知，尚无涉及小儿肾移植受者的已发表病例。因此，我们呈现了一个具有挑战性的临床病例，其中一名小儿肾移植受者出现复发性多重耐药泌尿道感染且感染源不明，在此病例中使用了噬菌体疗法。
我们的患者是一名17岁女性，最初因产超广谱β-内酰胺酶（ESBL）的大肠埃希菌引起泌尿道感染，当时因免疫抑制治疗依从性差继发肾排斥反应而接受免疫抑制治疗方案。她因产ESBL大肠埃希菌引起的4次泌尿道感染间歇性入住我院4个月。她接受了多疗程抗生素治疗（主要是厄他培南），并进行了粪便移植以根除其胃肠道定植的产ESBL大肠埃希菌。由于抗生素治疗后泌尿道感染反复发生，她后来接受了由2种分离株特异性噬菌体组成的噬菌体鸡尾酒治疗。经过长时间的抗生素疗程及随后3周的静脉噬菌体治疗，治疗后4年她的尿培养中未检出产ESBL大肠埃希菌。
本病例突出了治疗小儿肾移植患者复发性产ESBL大肠埃希菌感染的挑战，并提供了证据表明噬菌体疗法在这类病例中可能有用。
