Case 43

Patient 43 is a 63 year-old female with MRSA prosthetic joint infection of right hip and knee.  In July 2020, the knee underwent a 2-stage revision for a MRSA infection which failed.  This was followed by a 2-stage revision of the right hip in Sep2020. Both were performed without exchange.  In Jan2021, she received hip and knee spacers since both joints continued to be culture positive for MRSA with extreme purulence.  Despite IV antibiotic treatment, the patient maintained elevated CRP/ESR markers prior to phage therapy. She began phage therapy in March 2021, when she also received a staged procedure of debridement and spacer replacement of the hip and arthrotomy/incision and drainage of the knee, each with intraoperative doses of phage. The patient received 3 days of IV phage QD. Each dose was 1.95×109 PFU (10 ml of 1.95 x 108 PFU/mL).  The patient had not had elevated LFTs with previous surgeries.  Her LFTs increased 2 x ULN with IA phage but then did not increase further with repeated dosing.  Her elevated CRP/ESR markers fell to normal limits after receiving phage in Mar2021. Following phage therapy the patient is to complete 4 weeks of daptomycin followed by oral Bactrim until biomarkers are within normal limits for 2 weeks.