{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:46:38Z","timestamp":1791492398485,"version":"4.3.4"},"reference-count":10,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>We describe the first use of phage therapy in Canada for the treatment of a life-threatening periprosthetic joint infection (PJI), with successful outcome. PJI is a devastating complication of joint replacement surgery, with high morbidity and mortality. Our patient presented with early sepsis from a chronic recalcitrant multidrug-resistant (MDR) Staphylococcus epidermidis hip PJI which had repeatedly failed standard therapy. She had previously undergone 10 operations of the right hip, and only three weeks after completing a prolonged course of daptomycin following her most recent hip revision, she developed a draining sinus tract. Given the high burden of disease, inability to achieve surgical source control, and lack of antibiotic treatment options for long-term suppressive therapy, bacteriophage (phage) therapy was pursued. The patient underwent irrigation and debridement with complex flap reconstruction: intraoperative tissue cultures again yielded MDR S. epidermidis. We developed a novel phage therapy protocol for this patient, with twice daily, intra-articular and intravenous (7 \u00d7 109 PFU\/dose) phage delivery over a planned 14-day course. Complete healing of the wound with cessation of drainage occurred within one month after treatment. A marked improvement in right hip pain and mobility occurred within three months after treatment. Twelve months following phage treatment, there is normalization of serum inflammatory markers with diminished pain, increased mobility, and no recurrent surgery. Our patient continues to improve and is currently living independently at home, with sustained clinical control of infection.<\/jats:p>","DOI":"10.3390\/v17081118","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T14:51:46Z","timestamp":1755183106000},"page":"1118","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["First Use of Phage Therapy in Canada for the Treatment of a Life-Threatening, Multidrug-Resistant Staphylococcus epidermidis Periprosthetic Joint Infection"],"prefix":"10.3390","volume":"17","author":[{"given":"Melissa T.","family":"Cammuso","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8042-5660","authenticated-orcid":false,"given":"Bradley W. M.","family":"Cook","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0090-3539","authenticated-orcid":false,"given":"D. William","family":"Cameron","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada"},{"name":"Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielou","family":"Tamayo","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0232-6667","authenticated-orcid":false,"given":"Melissa J.","family":"Peters","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia","family":"Arnaud","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Lau","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2010-3264","authenticated-orcid":false,"given":"Henrik","family":"Almblad","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Fournier","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"LoVetri","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasia J.","family":"Lightly","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuen Ming","family":"Chung","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riya","family":"Roy","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Theriault","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven S.","family":"Theriault","sequence":"additional","affiliation":[{"name":"Cytophage Technologies, Ltd., Oak Bluff, MB R4G 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7434-6897","authenticated-orcid":false,"given":"Gina A.","family":"Suh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5454-3591","authenticated-orcid":false,"given":"Marisa A.","family":"Azad","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada"},{"name":"Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1007\/s11095-014-1617-7","article-title":"Quality and safety requirements for sustainable phage therapy products","volume":"32","author":"Pirnay","year":"2015","journal-title":"Pharm. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.arth.2012.02.022","article-title":"Economic burden of periprosthetic joint infection in the United States","volume":"27","author":"Kurtz","year":"2012","journal-title":"J. Arthroplasty."},{"key":"ref_3","unstructured":"(2024, December 16). Canadian Institute for Health Information. CJRR Annual Report: Hip and Knee Replacements in Canada, 2019\u20132020. Available online: https:\/\/www.cihi.ca\/sites\/default\/files\/document\/cjrr-full-annual-report-2019-2020-en.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Azad, M.A., and Patel, R. (2024). Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin. Microbiol. 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