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      Successful Treatment of Staphylococcus aureus Prosthetic Joint Infection with Bacteriophage Therapy

      case-report

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          Abstract

          Successful joint replacement is a life-enhancing procedure with significant growth in the past decade. Prosthetic joint infection occurs rarely; it is a biofilm-based infection that is poorly responsive to antibiotic alone. Recent interest in bacteriophage therapy has made it possible to treat some biofilm-based infections, as well as those caused by multidrug-resistant pathogens, successfully when conventional antibiotic therapy has failed. Here, we describe the case of a 61-year-old woman who was successfully treated after a second cycle of bacteriophage therapy administered at the time of a two-stage exchange procedure for a persistent methicillin-sensitive Staphylococcus aureus (MSSA) prosthetic knee-joint infection. We highlight the safety and efficacy of both intravenous and intra-articular infusions of bacteriophage therapy, a successful outcome with a single lytic phage, and the development of serum neutralization with prolonged treatment.

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          Most cited references31

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          Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci.

          The details of all steps involved in the quantification of biofilm formation in microtiter plates are described. The presented protocol incorporates information on assessment of biofilm production by staphylococci, gained both by direct experience as well as by analysis of methods for assaying biofilm production. The obtained results should simplify quantification of biofilm formation in microtiter plates, and make it more reliable and comparable among different laboratories.
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            Prosthetic joint infection.

            Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.
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              Phage therapy: An alternative to antibiotics in the age of multi-drug resistance

              The practice of phage therapy, which uses bacterial viruses (phages) to treat bacterial infections, has been around for almost a century. The universal decline in the effectiveness of antibiotics has generated renewed interest in revisiting this practice. Conventionally, phage therapy relies on the use of naturally-occurring phages to infect and lyse bacteria at the site of infection. Biotechnological advances have further expanded the repertoire of potential phage therapeutics to include novel strategies using bioengineered phages and purified phage lytic proteins. Current research on the use of phages and their lytic proteins, specifically against multidrug-resistant bacterial infections, suggests phage therapy has the potential to be used as either an alternative or a supplement to antibiotic treatments. Antibacterial therapies, whether phage- or antibiotic-based, each have relative advantages and disadvantages; accordingly, many considerations must be taken into account when designing novel therapeutic approaches for preventing and treating bacterial infections. Although much is still unknown about the interactions between phage, bacteria, and human host, the time to take phage therapy seriously seems to be rapidly approaching.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Viruses
                Viruses
                viruses
                Viruses
                MDPI
                1999-4915
                21 June 2021
                June 2021
                : 13
                : 6
                : 1182
                Affiliations
                [1 ]Department of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093, USA; ccramirezsanchez@ 123456health.ucsd.edu (C.R.-S.); rschooley@ 123456health.ucsd.edu (R.T.S.)
                [2 ]Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; fbgonzales@ 123456health.ucsd.edu (F.G.); mabuckley@ 123456health.ucsd.edu (M.B.)
                [3 ]Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, MD 21702, USA; Biswajit.biswas.civ@ 123456mail.mil (B.B.); matthew.s.henry23.ctr@ 123456mail.mil (M.H.); michael.v.deschenes.ctr@ 123456mail.mil (M.V.D.)
                [4 ]The Geneva Foundation, Tacoma, WA 98402, USA
                [5 ]Leidos, Reston, VA 20190, USA
                [6 ]Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA; bhorne@ 123456aphage.com (B.H.); jfackler@ 123456aphage.com (J.F.); mjbrownstein@ 123456gmail.com (M.J.B.)
                [7 ]Center for Innovative Phage Therapy and Applications, University of California San Diego, La Jolla, CA 92093, USA
                Author notes
                [* ]Correspondence: saslam@ 123456health.ucsd.edu ; Tel.: +1-858-657-7643; Fax: +1-858-587-6704
                Author information
                https://orcid.org/0000-0002-9012-7827
                Article
                viruses-13-01182
                10.3390/v13061182
                8233819
                34205687
                1cc8a955-3daf-40da-a7eb-f30c4a2131fd
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 20 May 2021
                : 14 June 2021
                Categories
                Case Report

                Microbiology & Virology
                bacteriophage,phage therapy,prosthetic joint
                Microbiology & Virology
                bacteriophage, phage therapy, prosthetic joint

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