Heterogeneous Klebsiella pneumoniae Co-infections Complicate Personalized Bacteriophage Therapy

Jinhong Qin; Jinhong Qin; Jinhong Qin; Nannan Wu; Juan Bao; Xin Shi; Hongyu Ou; Shanke Ye; Wei Zhao; Zhenquan Wei; Jinfeng Cai; Lisha Li; Mingquan Guo; Mingquan Guo; Jingyan Weng; Hongzhou Lu; Demeng Tan; Jianzhong Zhang; Qin Huang; Zhaoqin Zhu; Yejing Shi; Chunlan Hu; Xiaokui Guo; Xiaokui Guo; Tongyu Zhu; Tongyu Zhu; Tongyu Zhu

doi:10.3389/fcimb.2020.608402

Frontiers in Cellular and Infection Microbiology (Jan 2021)

Heterogeneous Klebsiella pneumoniae Co-infections Complicate Personalized Bacteriophage Therapy

Jinhong Qin,
Jinhong Qin,
Jinhong Qin,
Nannan Wu,
Juan Bao,
Xin Shi,
Hongyu Ou,
Shanke Ye,
Wei Zhao,
Zhenquan Wei,
Jinfeng Cai,
Lisha Li,
Mingquan Guo,
Mingquan Guo,
Jingyan Weng,
Hongzhou Lu,
Demeng Tan,
Jianzhong Zhang,
Qin Huang,
Zhaoqin Zhu,
Yejing Shi,
Chunlan Hu,
Xiaokui Guo,
Xiaokui Guo,
Tongyu Zhu,
Tongyu Zhu,
Tongyu Zhu

Affiliations

Jinhong Qin: Department of Microbiology and Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Jinhong Qin: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Jinhong Qin: School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Nannan Wu: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Juan Bao: Department of Urology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Xin Shi: Department of Microbiology and Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Hongyu Ou: School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
Shanke Ye: Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Wei Zhao: Experiment Teaching Center of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Zhenquan Wei: Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Jinfeng Cai: Department of Laboratory Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Lisha Li: 0Department of Microbiology, School of Basic Medical Science, Guizhou Medical University, Guiyang, China
Mingquan Guo: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Mingquan Guo: Department of Laboratory Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Jingyan Weng: 1Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Hongzhou Lu: Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Demeng Tan: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Jianzhong Zhang: 1Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Qin Huang: Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Zhaoqin Zhu: Department of Laboratory Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Yejing Shi: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Chunlan Hu: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Xiaokui Guo: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Xiaokui Guo: School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Tongyu Zhu: Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Tongyu Zhu: Department of Urology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Tongyu Zhu: 2Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China

DOI: https://doi.org/10.3389/fcimb.2020.608402
Journal volume & issue: Vol. 10

Abstract

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Multidrug-resistant (MDR) organisms have increased worldwide, posing a major challenge for the clinical management of infection. Bacteriophage is expected as potential effective therapeutic agents for difficult-to-treat infections. When performing bacteriophage therapy, the susceptibility of lytic bacteriophage to the target bacteria is selected by laboratory isolate from patients. The presence of a subpopulation in a main population of tested cells, coupled with the rapid development of phage-resistant populations, will make bacteriophage therapy ineffective. We aimed to treat a man with multifocal urinary tract infections of MDR Klebsiella pneumoniae by phage therapy. However, the presence of polyclonal co-infectious cells in his renal pelvis and bladder led to the failure of three consecutive phage therapies. After analysis, the patient was performed with percutaneous nephrostomy (PCN). A cocktail of bacteriophages was selected for activity against all 21 heterogeneous isolates and irrigated simultaneously via the kidney and bladder to eradicate multifocal colonization, combined with antibiotic treatment. Finally, the patient recovered with an obviously improved bladder. The success of this case provides valuable treatment ideas and solutions for phage treatment of complex infections.Clinical Trial Registrationwww.chictr.org.cn, identifier ChiCTR1900020989.

Published in Frontiers in Cellular and Infection Microbiology

ISSN: 2235-2988 (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Science: Microbiology
Website: http://www.frontiersin.org/Cellular-and-Infection-Microbiology

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