Medicine in Microecology · Published 2026-05-21 · DOI 10.1016/j.medmic.2026.100178
Ajay Kumar, Alka Shukla, S. Alshad, Pankaj Kumar, Gopal Nath
Background: Prosthetic joint infections (PJIs) caused by multidrug-resistant (MDR) bacteria and biofilm formation are often refractory to standard surgical and antibiotic care. Personalized bacteriophage therapy has emerged as a targeted alternative for such cases. Methods: We present a descriptive case series of three patients with chronic MDR PJIs after total knee replacement (TKR) who were treated with locally applied high-titer lytic bacteriophage preparations. Clinical isolates were identified and characterized; environmental phages were isolated, purified, titrated, and tested for host specificity before local therapy. Outcomes were assessed clinically and microbiologically during follow-up. Results: All three patients (MDR Staphylococcus aureus, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Pseudomonas aeruginosa) achieved complete wound healing and resolution of infection while retaining their prostheses. Healing times were 56, 60, and 45 days, respectively; no recurrences were observed during the reported follow-up period. Phage titers ranged from 106 to 109 PFU/mL; therapy was well tolerated, with no reported adverse events. Conclusion: In this series, personalized, locally applied bacteriophage therapy was as safe and effective as a prosthesis-preserving rescue strategy for refractory MDR PJIs. These findings support further clinical evaluation and protocol standardization for the use of phages in the treatment of complex orthopedic infections.
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Kumar, A., Shukla, A., Alshad, S., et al. (2026). Harnessing bacteriophages to combat antibiotic-resistant chronic postoperative infections: A promising case series. Medicine in Microecology. https://doi.org/10.1016/j.medmic.2026.100178