Smartphone-Based Detection of Middle Ear Fluid.

Abstract

Engineered Phage Treatment A pediatric patient with cystic fibrosis and a double-lung transplant received a genetically engineered 3-phage cocktail to treat a lifethreatening antibiotic-resistant Mycobacterium abscessus infection for which all standardtherapeuticoptionshadbeenexhausted. Over 7 months of twice-daily intravenous infusions, as well as daily topical phage therapy, the 15-year-old patient’s surgical wound and skin lesions healed gradually and her lung and liver function improved. No adverse reactions to the treatment were reported. Bacteriophages are viruses that infect and kill bacteria. Phage therapy, used by some in the early 20th century to treat infections, is receiving renewed interest amid the rise of antibiotic-resistant pathogens. The recent experimental treatment, described in Nature Medicine, is the first known use of engineered bacteriophage in a patient. After screening a collection of phage candidates, researchers identified one that efficiently killed the patient’s M abscessus strain. They genetically modified 2 other promising candidate phages to enhance their killing effects, combining the 3 into a powerful therapeutic cocktail. Although the patient’s infection has not completely resolved with the ongoing treatments, she “has done remarkably well and has returned to normal activities,” the study’s co-senior author, Graham Hatfull, PhD, of the University of Pittsburgh, told JAMA. Drug resistance to mycobacteria—a group of pathogens that includes the tuberculosiscausing M tuberculosis—is widespread. However, what worked for this patient’s strain won’t necessarily work for others, Hatfull cautioned. “A major challenge is... to assemble a collection of phages that could be broadly used for treating these and other nontuberculous mycobacteria infections,” he said.