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4-027 Phage therapy – back to the future
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Journal Article
4-027 Phage therapy – back to the future
2025
Overview
IntroductionPhage therapy, initially theorised in 1920’s Soviet Union, was overlooked with the widespread introduction of antimicrobials, but is now making a comeback. We present a unique case of the administration of phage therapy in a 94-year-old male, who suffered with recurrent pseudomonas infections secondary to incomplete extraction of a pacemaker. Currently, the awareness of phage therapy is limited outside of clinical trials, with narrow insight into available applications within cardiology in the UK.BackgroundThe patient had a permanent pacemaker inserted for sinus node dysfunction in 2009. Following this, he had an elective generator change which was complicated by a pseudomonas infection. Attempted extraction of this was incomplete, with a residual pacing tip remaining in the right ventricle. After all options were exhausted, including further surgical intervention, he was referred for bacteriophage therapy in 2024.Bacteriophages are intracellular viruses that selectively target and infect bacterial cells by hijacking their genome, inducing lysis. Phage therapy targets drug resistant pathogens whilst retaining selective toxicity, ensuring protection of the hosts biome. Uniquely, their ability to penetrate bacterial biofilms, enhances their therapeutic potential.As phage is not manufactured, nor licensed in the UK, an array of logistical issues were encountered in this case, resulting in a delay of treatment by over 4 weeks. Despite these challenges, phage therapy was successfully commenced making this a pioneering case at the forefront of cardiology.The patient ultimately died of complications of clinical deconditioning and frailty. However, this case demonstrates the use of phage therapy and its potential as a promising alternative for those facing severe infections on a background of significant antibiotic resistance.ConclusionThe future of phage therapy is exciting and promising, however there are many hurdles yet to overcome.Given the significant clinical risk and logistical challenges often associated with long term IV antibiotic use, phage therapy has a vast scope for application in the UK. Cases like this highlight the potential for phage therapy as a treatment option within cardiology patients, where no other avenues remain available.
Publisher
BMJ Publishing Group LTD
Subject
