![]() This case demonstrated the feasibility of the use of bacteriophages within a hydrogel to treat patients for knee megaprosthesis infection during a debridement procedure. We also evaluated in vitro the impact of DAC ® hydrogel on bacteriophage activity and showed that the selected phages were released very rapidly from the DAC ® hydrogel, and then their titers were stable for at least 6 h. As a consequence, a transfemoral amputation was finally performed several months later. Unfortunately, at 5 days after the surgery, while the local aspect of the surgical site was favorable, the patient developed myocardial infarction which required emergency stenting and dual antiplatelet therapy that were rapidly associated with bleeding at the surgical site, leading to a new prosthesis exposition. A free flap for soft tissue coverage was required and empirical antibiotic treatment was started immediately after the surgery. Then, we performed, as salvage therapy, a debridement and implant retention procedure with application of a selected cocktail of bacteriophages that was prepared extemporaneously within the DAC ® hydrogel. We firstly perform phage susceptibility testing of the patient's strain to select an active cocktail, under the supervision of the French health authority. We report here the case of a patient with a catastrophic relapsing Staphylococcus aureus knee megaprosthesis infection without prosthesis loosening. The Defensive Antibacterial Coating (DAC ®) hydrogel is a hydrogel available in the market that has been designed to prevent the adherence of bacteria on a prosthetic joint and to have the ability to transport and release anti-bacterial substances such as antibiotics. Lytic bacteriophages are considered to have a high potential in patients with prosthetic joint infection as it has been demonstrated that they have a synergistic anti-biofilm activity with antibiotics. ![]() Its management is more complex in comparison with patients with primary arthroplasty, with a high risk of relapse. Infection is the most dramatic complication in patients with knee megaprosthesis. 10Institut des Agents Infectieux, Laboratoire de Bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.9Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.8Service de Maladies Infectieuses, Centre Hospitalier Metropole Savoie, Chambéry, France.7Service de Chirurgie Plastique et Reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.6Pherecydes Pharma, Romainville, France.5Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.4CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ.3Centre Interrégional de Référence pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.2Université Claude Bernard Lyon 1, Lyon, France.1Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.Tristan Ferry 1,2,3,4 *, Cécile Batailler 2,3,5, Charlotte Petitjean 6, Joseph Chateau 7, Cindy Fevre 6, Emmanuel Forestier 8, Sophie Brosset 7, Gilles Leboucher 9, Camille Kolenda 2,3,4,10, Frédéric Laurent 2,3,4,10 and Sébastien Lustig 2,3,5 on behalf of the Lyon BJI Study Group
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