Artikel
Bacteriophage therapy plus fecal microbiota transplantation to treat recurrent urinary tract infection (rUTI): a case series
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Autoren
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Annika Y. Claßen
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
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Shawna McCallin
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Jens Scheidegger
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Sarah Dugas
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Simone Lieberknecht
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Hendrik Koliwer-Brandl
- Institute of Medical Microbiology, University of Zürich, Zürich, Switzerland
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Swenja Lassen
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Matthew Dunne
- Institute for Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
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Oksana Chemych
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Prossie Lindah Nankya
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Sonja Milek
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Maria J. G. T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Lena M. Biehl
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| Veröffentlicht: | 20. November 2024 |
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Gliederung
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Introduction: Recurrent urinary tract infections (rUTIs) are a chronic and debilitating condition often characterized by repeated treatment failures with antibiotics. This case report explores a novel approach aimed at decolonizing intestinal and urinary reservoirs of the causative pathogen, Escherichia coli, using a combined strategy of phage therapy followed by fecal microbiota transplantation (FMT).
Methods: This case series involved three female patients with rUTIs attributed to a stable E. coli strain. The intervention consisted of oral and intravesical administration of a two-phage cocktail, administered twice daily for 8 and 6 days, respectively. Following this, two patients received oral antibiotics in preparation for FMT. The efficacy of the treatments was evaluated through microbiological assessments, including changes in urine E. coli titers and the detection of phage in urine and stool. The safety and tolerability of the phage therapy and FMT were also assessed, alongside patient-reported outcomes.
An overview of the treatment schedule can be seen in Figure 1 [Fig. 1].
Results: Among the treated patients, two exhibited a significant reduction in urine E. coli levels, with titers decreasing to low or undetectable levels after intravesical phage administration. However, in one patient, the E. coli strain developed resistance to both phages within five days. Phage was detected in the urine and stool of patients only transiently following administration. Despite this, all patients well tolerated the phage and FMT treatments without any related adverse events. Five months post-treatment, none of the patients had experienced further UTI episodes, and all reported subjective clinical improvement. E. coli was detected in the urine of all patients post-treatment.
Conclusion: The initial application of phage therapy demonstrated a rapid reduction in bacteriuria in patients with rUTIs. Although the combined treatment of phage therapy and FMT was well tolerated with no adverse events and patients reported subjective improvement, microbiological sterilization of E. coli was not achieved. The case series highlights the potential of phage therapy and FMT as a novel treatment modality for rUTIs, suggesting the need for further research into its long-term efficacy and impact on microbial and immune responses.
