{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:37:31Z","timestamp":1790786251101,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    Extensively drug-resistant (XDR)\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    pneumonia carries severe pneumonia, respiratory failure and high mortality, showing limited therapeutic options in critically ill patients. Although bacteriophage (phage) therapy represents a promising alternative against drug-resistant infections, its clinical use remains largely empirical. Here, we reported a systematically planned phage-antibiotic combination strategy in a critically ill patient with refractory XDR\n                    <jats:italic>A. baumannii<\/jats:italic>\n                    pneumonia. A virulent phage targeting the patient-derived strain was isolated from hospital wastewater and classified within the class\n                    <jats:italic>Caudoviricetes<\/jats:italic>\n                    , with no virulence, toxin, or antibiotic resistance genes.\n                    <jats:italic>In vitro<\/jats:italic>\n                    time-kill assays showed that phage monotherapy failed to persistently suppress bacteria proliferation, whereas phage-antibiotic therapy achieved synergistic inhibition of\n                    <jats:italic>A. baumannii<\/jats:italic>\n                    growth for over 48\u00a0h. The patient received nebulized phage therapy (5 \u00d7 10\n                    <jats:sup>9<\/jats:sup>\n                    PFU\/mL twice daily) combined with intravenous fosfomycin (8\u00a0g, every 8 hours), amikacin (0.2\u00a0g, every 12 hours), and polymyxin B (500, 000 U, every 12 hours). Clinically, treatment was associated with rapid normalization of arterial carbon dioxide tension (PaCO2), clearance of A. baumannii sputum cultures by day 4, declining inflammatory markers, and no treatment-related toxicity.Longitudinal metagenomic sequencing further revealed approximately 52-fold reduction in pathogen abundance and significant decrease of\n                    <jats:italic>A. baumannii<\/jats:italic>\n                    -associated antimicrobial resistance genes (ARGs) in the lung, highlighting the potential of precision phage-antibiotic therapy for recalcitrant XDR bacterial infections.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2026.1851410","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:23:20Z","timestamp":1783571000000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Phage-antibiotic synergy attenuates Acinetobacter baumannii resistance in refractory pneumonia: a precision therapeutic case"],"prefix":"10.3389","volume":"16","author":[{"given":"Lei","family":"Zhang","sequence":"first","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]},{"name":"School of Medicine, Shenzhen University","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexin","family":"Yan","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengli","family":"Xu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyu","family":"Xiao","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Guo","sequence":"additional","affiliation":[{"name":"School of Public Health, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiqin","family":"Dai","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Lin","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deliang","family":"Liu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man","family":"Rao","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Lin","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Zhao","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]},{"name":"Guangdong Key Lab for Diagnosis & Treatment of Emerging Infectious Diseases, Shenzhen Third People\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingbin","family":"Zheng","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]},{"name":"The Affiliated Dongguan Songshan Lake Central Hospital, Guangdong Medical University","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhou","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]},{"name":"Molecular Biology Research Center & Center for Medical Genetics, School of Life Sciences, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhou","family":"Lu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Infectious Disease, Shenzhen Third People\u2019s Hospital, Southern University of Science and Technology","place":["Shenzhen, China"]},{"name":"Guangdong Key Lab for Diagnosis & Treatment of Emerging Infectious Diseases, Shenzhen Third People\u2019s Hospital","place":["Shenzhen, 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