Case 39

Patient #39 is 83 years old with a past medical history of chronic atrial fibrillation, coronary artery disease, hypertension and hyperlipidemia. On 12Oct2020 a chest x-ray showed peripheral rounded cotton ball infiltrates in the right upper lobe. Sputum culture was positive for CRAB on 19Oct2020 which was resistant to all antibiotics but showed intermediate susceptibility to tigecycline. Phage therapy IV was initiated on 22Oct2020 which was dosed twice a day. Over the next month, multiple sputum cultures were positive for CRAB and nebulized phage was added to IV therapy on 12Nov2020. A total of 50 doses of IV phage was administered over 27 days and 26 nebulized doses were administered over 2 weeks. Following initiation of nebulized phage, two negative cultures for CRAB were noted on 20Nov2020, 21Nov2020 and 26Nov2020 (but positive for Klebsiella pneumoniae and Achromobacter xylosoxidans). However, the sputum culture was positive for CRAB on 25Nov2020 and 28Nov2020. All 11 blood cultures taken during hospitalization were negative for CRAB. No adverse events were reported as related to phage therapy. Liver enzymes AST/ALT/ALP/TB were slightly elevated prior to starting phage therapy on 22Oct2020. Upon discharge on 01Dec2020 these values were still higher than normal.