Use of bacteriophages in the treatment of colistin-only-sensitive Pseudomonas aeruginosa septicaemia in a patient with acute kidney injury—a case report

Abstract

Sepsis from Pseudomonas aeruginosa bacteraemia may be fatal, especially when no appropriate therapy can be given. In June 2016, a 61-year-old man was hospitalised for Enterobacter cloacae peritonitis and severe abdominal sepsis with disseminated intravascular coagulation, secondary to a diaphragmatic hernia with bowel strangulation. The patient had a prolonged hospital course complicated by gangrene of the peripheral extremities, resulting in the amputation of the lower limbs and the development of large necrotic pressure sores (Fig. 1). Three months after admission, the patient was transferred to the Queen Astrid military hospital for surgical management of the pressure sores. Wound cultures on admission revealed colonisation with, amongst others, multidrug-resistant P. aeruginosa. One month after admission, the patient developed septicaemia with colistin-only-sensitive P. aeruginosa. Intravenous colistin therapy was started. Ten days later, the patient developed acute kidney injury with rising serum creatinine and urea levels (Fig. 2), presumably sepsisand drug-induced. Antibiotic therapy was discontinued to prevent further kidney damage. Unfortunately, on 12 November, P. aeruginosa septicaemia re-emerged with rapid heart rate, low blood pressure, fever and high C-reactive protein (CRP) levels. On 14 November, the patient went into a coma with 9 scores (E2V2M5) on the Glasgow Coma Scale. Because of the risk of colistin nephrotoxicity and the family’s will to avoid intensive therapy interventions such as hemofiltration, bacteriophage therapy was initiated under the umbrella of Article 37 (Unproven Interventions in Clinical Practice) of the Declaration of Helsinki [1]. Fifty microlitres of purified bacteriophage cocktail BFC1 [2], containing two bacteriophages that showed in vitro activity against the patient’s P. aeruginosa