Tseng Chun-Chieh, Chen Li-Kuang, Chu Hsiu-Tzu, Chen Yi-Ting, Jiang Hui-Li, Yang Hui-Hua, Chang Chin-Cheng, Debangana Sankhla, Ponge Lee-Mei, Li Min-Xiu, Chin Ying-Hao, Chang Jui-Chih
Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan.
Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Clinical Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Int J Antimicrob Agents. 2025 Feb;65(2):107413. doi: 10.1016/j.ijantimicag.2024.107413. Epub 2024 Dec 19.
Phage-based decontamination has rarely been explored in real-world settings, particularly in the environments of patients undergoing extracorporeal membrane oxygenation (ECMO). This four-year prospective study aimed to evaluate the effectiveness of aerosolized phage cocktails tailored to combat target antibiotic-resistant species of Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The decontamination procedure with phage aerosols was proactively implemented before the admission of ECMO patients based on a thorough analysis of phage typing results from bacterial species isolated from prospective patient areas during the preceding two months. The phage cocktail formulation design also accounted for phage resistance development, phage families, and plaque characteristics. Throughout the study, 85 ECMO patients were monitored, with the environments of 22 patients undergoing phage decontamination. Fifty phage cocktails were prepared to target the identified species. Respiratory infections were most common among ECMO patients, accounting for 71.4 %. The ECMO duration for patients infected with the targeted species was significantly longer than that for noninfected patients (P = 0.019), with peak infection incidence occurring between 3 and 7 days of ECMO treatment (67.1 per 1000 ECMO days). Notably, none of the patients in phage-treated environments contracted infections from the targeted species. However, the overall incidence of bacterial infections did not significantly correlate with phage decontamination efforts, as phages are effective only against their specific hosts. This study demonstrates the potential of prophylactic phage decontamination to prevent specific infections, aligning with One Health principles by offering a sustainable alternative to antibiotics, potentially significantly reducing antibiotic use.
基于噬菌体的去污方法在实际环境中很少被探索，尤其是在接受体外膜肺氧合（ECMO）治疗的患者环境中。这项为期四年的前瞻性研究旨在评估雾化噬菌体鸡尾酒针对鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和嗜麦芽窄食单胞菌等目标耐药菌的有效性。在ECMO患者入院前，根据对前两个月从预期患者区域分离出的细菌物种的噬菌体分型结果进行全面分析，主动实施噬菌体气溶胶去污程序。噬菌体鸡尾酒配方设计还考虑了噬菌体耐药性的发展、噬菌体家族和噬菌斑特征。在整个研究过程中，对85名ECMO患者进行了监测，其中22名患者的环境接受了噬菌体去污处理。制备了50种噬菌体鸡尾酒以针对已鉴定的物种。呼吸道感染在ECMO患者中最为常见，占71.4%。感染目标物种的患者的ECMO持续时间明显长于未感染患者（P = 0.019），感染发病率高峰出现在ECMO治疗的3至7天之间（每1000个ECMO日67.1例）。值得注意的是，接受噬菌体处理环境中的患者均未感染目标物种。然而，细菌感染的总体发生率与噬菌体去污措施没有显著相关性，因为噬菌体仅对其特定宿主有效。这项研究证明了预防性噬菌体去污在预防特定感染方面的潜力，通过提供抗生素的可持续替代品符合“同一健康”原则，有可能显著减少抗生素使用。
