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Chronic suppression of a multidrug-resistant Pseudomonas aeruginosa in prosthetic joint infection using personalized

Rekha Arya1, Dongzhu Ma1, Jewelia J Rempuszewski1

  • 1Department of Orthopaedic Surgery, Bethel Musculoskeletal Research Center, Arthritis and Arthroplasty Design Lab, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Nature Communications
|June 27, 2026
PubMed

Insights

Bacteriophage therapy offers a novel treatment for multidrug-resistant (MDR) infections, particularly those linked to medical implants. This approach successfully resolved a severe Pseudomonas aeruginosa infection, demonstrating potential when antibiotics fail.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Biotechnology

Background:

  • Multidrug-resistant (MDR) bacterial infections pose a significant public health threat, especially in cases involving medical implants.
  • Conventional antibiotics are often ineffective against biofilms, which protect bacteria and contribute to persistent infections.
  • Pseudomonas aeruginosa periprosthetic joint infections are challenging to treat, often requiring extensive interventions.

Purpose of the Study:

  • To evaluate the efficacy of bacteriophage therapy as a standalone treatment for a MDR Pseudomonas aeruginosa periprosthetic joint infection.
  • To investigate the impact of bacteriophage therapy on infection virulence and biofilm structure.
  • To assess the long-term clinical and microbiological outcomes of bacteriophage therapy in a salvage case.

Main Methods:

  • A patient with a MDR Pseudomonas aeruginosa periprosthetic joint infection, unresponsive to antibiotics and surgery, received intermittent bacteriophage therapy over two years.
  • Whole genome sequencing was employed to monitor bacteriophage presence and potential genetic changes during treatment.
  • Clinical symptoms, disease severity, and biofilm characteristics were assessed to evaluate treatment response.

Main Results:

  • Bacteriophage therapy alone led to clinical resolution of the infection over the two-year treatment period.
  • While clinical symptoms improved, microbiological eradication of Pseudomonas aeruginosa was not achieved.
  • Bacteriophage therapy demonstrated an ability to alter bacterial virulence and disrupt biofilm formation.
  • Whole genome sequencing confirmed the sustained presence of bacteriophages throughout the treatment duration.

Conclusions:

  • Bacteriophage therapy presents a viable therapeutic option for managing MDR infections in salvage situations where conventional treatments are unavailable or have failed.
  • The therapy effectively controlled infection symptoms and virulence, highlighting its potential beyond direct bacterial killing.
  • Further research is warranted to optimize bacteriophage therapy protocols for complete microbiological eradication in chronic infections.

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