Novel Treatment Approach for Acute Trauma Related Osteomyelitis with Extremely-Resistant Bacterial Infection

Introduction: Acute and chronic surgical site infections (SSI) a major treatment challenge in orthopedic surgery. The main obstacle in those infections is biofilm and bacterial persistence that associated with implants and traumatized bone structures

Case: 42 years old healthy man was admitted to our trauma center with multiple injuries following motor vehicle accident. Most significantly he suffered from bilateral Grade III A open fractures: A right distal femoral fracture (DF) and a left bicondylar tibial plateau with compartment syndrome . The right DF fracture was infected XDR Acinetobacter baumanii and Klebsiella penumniae successfully treated with long-term intravenous antibiotics. The patient underwent secondary bone grafting and fixation of his left tibial plateau. Intraoperative biopsies confirmed the existence of a MDR Acinetobacter baumanii, following by wound breakdown that was treated with local irrigation, debridement and coverage with local rotational flap (LGF) .

Due to the highly resistant pathogens, the complicated type of infection, and severe tissue damage, the patient was offered to have above knee amputation and refused. Consideration of all possible approached yielded the remote possibility of using bacteriophages as a last resort for salvage adjacent to the LGF and continue prolonged use of antibiotics. Bacteriophages were obtained. Clinical improvement was evident mainly by local soft tissue healing and confirmed by laboratory tests, with eradication of the pathogen in the affected limb. Implants were retained throughout clinical course. The patient was discharged shortly later to rehabilitation free of antibiotic treatment.

Discussing: The treatment of orthopedic infections especially in the presence of MDR and XDR pathogens is extremely challenging. . Phage therapy has many promising advantages such as high specificity, biofilm-degradation ability, and lack of major adverse effect if properly manufactured. Here we presented one initial case might serve as a proof of concept for further trials.