472 days and counting.   OK, that’s not really accurate.

My infection- Klebsiella pneumoniae of the calf- has been arrested.  I was lucky (educated?) enough to recognize the microbe, get a PICC line inserted, and self-administered a combination of some pretty virulent antibiotics pretty much around the clock for a few months to stop the (subsequently developed necrotizing fasciitis) infection cold.

What you don’t know is K. pneumoniae is a microbe that normally attacks the lungs.  You might even recognize what disease it causes from its name- pneumonia.  Getting that microbe to infect and infest your leg if very rare.

But, the problem is that K. pneumoniae is a pretty virulent microbe.  It can develop biofilms, avoid actions from our immune system, and can easily evolve new variants (by transduction or plasmid transfer).

But, during my treatment, a mistake was made- the cast fell down and gouged my ankle, severing the Achilles tendon and letting the infection spread to that region.  And, that’s the situation I’ve been dealing with this long.

So, when I find another such case, I follow it with great interest.

Lo and behold, there’s another case- not quite the same, but similar.  And, the treatment protocol makes it even more interesting.

A 30 y old woman was injured by a terrorist bombing in Brussels.  The suicide bomber left her in bad shape.  While being treated at Erasme Hospital in Belgium, her wounds evidenced an infection of K. pneumoniae.  And, that microbe- when infecting tissues or bones other than the lungs- is extremely recalcitrant.

As was true for me, this woman did not respond well to the chosen antibiotic regimen; the microbe was winning.

Dr. A. Eskanazi decided it was time to try a ‘Hail Mary’ approach.  He opted to try phage therapy.  (I’ve discussed this concept back in 2017- the use of bacteriophage to treat antibiotic resistant microbes.)  So, he sent a sample of the offending microbes to the Eliava Institute (Tbilisi, Georgia), so they could identify a phage that would attack the infection.  (This institute has been using phage therapy for a century already!!!!)  Well, they not only found a suitable virus, they mutated it to be an even more apt choice.

Of course, the therapy did not immediately commence, because phage therapy is not considered “acceptable” in Belgium.  It took 2 years to get the therapy approved (more than 700 days)- and within weeks, her condition improved. Her broken femur is healed and she is learning to walk again.

(You can read more about this case here:  Combination of pre-adapted bacteriophage therapy and antibiotics for treatment of fracture-related infection due to pandrug-resistant Klebsiella pneumoniae.  Besides Dr. Esekenazi, the other authors are Drs. M. Jayankura and M. Hites [both also from Erasme Hospital]; N. Balarjishvili, L. Leshkasheli, L. Askilashvili, L. Kvachadze, N. Chanishvili, and M. Kutateladze [Eliava Institute, Tbilisi], J. Wubbolts, M. de Boer, P. Nibbering, and V van Noort [Leiden University, Netherlands]; C. Lood, J. Wagemans, and R. Lavigne [KU Leuven,   Belgium]; and M. Merabishvili, and J-P. Pirnay (Queen Astrid Military Hospital, Belgium].)

The real problems are that modifying phages to yield superior results takes time and too many docs are resistant to the concept.  It takes many courses of failed antibiotic regimens to force these practitioners to modify their biases.  But, if we had a slew of “off-the-shelf phages” that could supplement antibiotic regimens, the technique would probably be more frequently employed.  Oh, as long as regulatory approval was in the offing.

Maybe it’s time.  There are too many antibiotic-resistant microbes.

(By the way, Dr. Eskenazi now practices at the Cayenne Hospital Center [French Guyana].  He’s no longer in Belgium.)