Bacteriophage application for difficult-to-treat musculoskeletal infections: development of a standardized multidisciplinary treatment protocol

Jolien Onsea, Patrick Soentjens, Sarah Djebara, Maia Merabishvili, Melissa Depypere, Isabel Spriet, Paul De Munter, Yves Debaveye, Stefaan Nijs, Paul Vanderschot, Jeroen Wagemans, Jean-Paul Pirnay, Rob Lavigne, Willem-Jan Metsemakers

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Bacteriophage therapy has recently attracted increased interest, particularly in difficult-to-treat infections. Although it is not a novel concept, standardized treatment guidelines are currently lacking. We present the first steps towards the establishment of a "multidisciplinary phage task force" (MPTF) and a standardized treatment pathway, based on our experience of four patients with severe musculoskeletal infections. After review of their medical history and current clinical status, a multidisciplinary team found four patients with musculoskeletal infections eligible for bacteriophage therapy within the scope of Article 37 of the Declaration of Helsinki. Treatment protocols were set up in collaboration with phage scientists and specialists. Based on the isolated pathogens, phage cocktails were selected and applied intraoperatively. A draining system allowed postoperative administration for a maximum of 10 days, 3 times per day. All patients received concomitant antibiotics and their clinical status was followed daily during phage therapy. No severe side-effects related to the phage application protocol were noted. After a single course of phage therapy with concomitant antibiotics, no recurrence of infection with the causative strains occurred, with follow-up periods ranging from 8 to 16 months. This study presents the successful outcome of bacteriophage therapy using a standardized treatment pathway for patients with severe musculoskeletal infection. A multidisciplinary team approach in the form of an MPTF is paramount in this process.

Original languageEnglish
Article number891
Issue number10
Publication statusPublished - 23-Sept-2019


  • Anti-Bacterial Agents/pharmacology
  • Bacteria/classification
  • Bacteriolysis
  • Bacteriophages
  • Clinical Protocols/standards
  • Combined Modality Therapy
  • Drug Resistance, Multiple, Bacterial
  • Humans
  • Microbial Sensitivity Tests
  • Musculoskeletal Diseases/microbiology
  • Osteomyelitis/microbiology
  • Patient Care Team/standards
  • Perioperative Period
  • Phage Therapy/methods
  • Treatment Outcome


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