Journal Article

Personalized bacteriophage therapy outcomes for 100 consecutive cases: a multicentre, multinational, retrospective observational study

Spiessens, An, de Jode, Mathieu, Soentjens, Patrick, Rose, Thomas, Green, Sabrina, Chanishvili, Nina, Merabishvili, Maya, Glonti, Tea, Cochez, Christel, Van Nieuwenhuyse, Brieuc, Lood, Cédric, Wagemans, Jeroen, Onsea, Jolien, Pirnay, Jean-Paul, Vanden Berghe, Emily, Draye, Jean-Pierre, Ceyssens, Pieter-Jan, De Vos, Daniel, De Soir, Steven, Schrevens, Eddie, Verbeken, Gilbert, Griselain, Johann, Kutateladze, Mzia, Djebara, Sarah, Steurs, Griet, Lavigne, Rob

2024

Overview

In contrast to the many reports of successful real-world cases of personalized bacteriophage therapy (BT), randomized controlled trials of non-personalized bacteriophage products have not produced the expected results. Here we present the outcomes of a retrospective observational analysis of the first 100 consecutive cases of personalized BT of difficult-to-treat infections facilitated by a Belgian consortium in 35 hospitals, 29 cities and 12 countries during the period from 1 January 2008 to 30 April 2022. We assessed how often personalized BT produced a positive clinical outcome (general efficacy) and performed a regression analysis to identify functional relationships. The most common indications were lower respiratory tract, skin and soft tissue, and bone infections, and involved combinations of 26 bacteriophages and 6 defined bacteriophage cocktails, individually selected and sometimes pre-adapted to target the causative bacterial pathogens. Clinical improvement and eradication of the targeted bacteria were reported for 77.2% and 61.3% of infections, respectively. In our dataset of 100 cases, eradication was 70% less probable when no concomitant antibiotics were used (odds ratio = 0.3; 95% confidence interval = 0.127–0.749). In vivo selection of bacteriophage resistance and in vitro bacteriophage–antibiotic synergy were documented in 43.8% (7/16 patients) and 90% (9/10) of evaluated patients, respectively. We observed a combination of antibiotic re-sensitization and reduced virulence in bacteriophage-resistant bacterial isolates that emerged during BT. Bacteriophage immune neutralization was observed in 38.5% (5/13) of screened patients. Fifteen adverse events were reported, including seven non-serious adverse drug reactions suspected to be linked to BT. While our analysis is limited by the uncontrolled nature of these data, it indicates that BT can be effective in combination with antibiotics and can inform the design of future controlled clinical trials. BT100 study, ClinicalTrials.gov registration: NCT05498363 . Analysis of 100 consecutive personalized bacteriophage therapy cases supports the use of personalized and sometimes pre-adapted, bacteriophage preparations, often in combination with antibiotics.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Springer Science and Business Media LLC
• Subject: 45 / 45/22 / 45/23 / 45/77 / 631/326/1321 / 631/326/22/1434 / 631/326/325/2482 / 64 / 692/699/255/1318 / Adolescent / Adult / Aged / Aged, 80 and over / Anesthesia & intensive care / Anesthésie & soins intensifs / Anti-Bacterial Agents - therapeutic use / Antibiotics / Bacteria - genetics / Bacteria - virology / Bacterial Infections - therapy / Bacteriophages - genetics / Bacteriophages - physiology / Belgium / Biomedical and Life Sciences / Child / Child, Preschool / Clinical trials / Eradication / Female / Human health sciences / Humans / Immunologie & maladie infectieuse / Immunology & infectious disease / Infant / Infections / Infectious Diseases / Life Sciences / Male / Medical Microbiology / Microbiology / Middle Aged / Parasitology / Patients / Phage Therapy - methods / Phages / Precision Medicine - methods / Respiratory tract / Retrospective Studies / Sciences de la santé humaine / Treatment Outcome / Virology / Virulence / Young Adult