Bacteriophage therapy for empyema caused by carbapenem-resistant Pseudomonas aeruginosa

Pseudomonas aeruginosa is a frequent causative agent of post-pneumonectomy empyema-associated broncho-pleural fistula (BPF) and it has a high mortality rate. In recent years, the therapeutic potential of bacteriophage therapy has recognized anew as antimicrobial resistance increases globally. Studies are increasingly reporting the efficacy and safety of bacteriophage therapy for the treatment of multidrug-resistant bacterial infections. However, the clinical efficacy of bacteriophage therapy in empyema has seldom been studied. The current study reports the authors' experience with bacteriophage therapy for a 68-year-old Chinese man who suffered BPF-associated empyema and pneumonia caused by carbapenem-resistant P. aeruginosa. A personalized lytic pathogen-specific two-phage preparation was administered to the patient continuously for 24 days in combination with conventional antibiotics. The treatment was well-tolerated, resulting in clearance of the pathogen and improvement of the clinical outcome. This experience shows that a combined conventional antibiotic treatment with bacteriophage therapy may be effective at alleviating a multidrug-resistant bacterial infection in BPF-associated empyema.