Successful Investigational Phage Therapy for Pan-Resistant Bacterial Mediastinitis Following Type II Hybrid Aortic Arch Replacement

A 47-year-old woman presented to our hospital with Stanford type B aortic dissection with retrograde arch extension. The decision was made to undergo hybrid arch repair with thoracic endovascular aortic repair. The patient underwent surgery, but her intraoperative course was complicated by delayed sternal closure and mediastinitis requiring flap reconstruction. Recurrent pan resistant Klebsiella sternal wound infection (SWI) was observed, for which successful investigational bacteriophage therapy initiated through mediastinal drains. She remains infection-free at 2-year follow-up. SWI is a morbid complication following cardiac surgery, particularly when colonized by pan-resistant bacterium. Phage therapy refers to the therapeutic use of modified bacteriophages and have been previously described for use in mediastinitis. We report the use of phage therapy to treat Klebsiella SWI in our patient. This case report adds to the current evidence supporting the use of phage therapy for treatment of complicated mediastinal wound infection following aortic arch surgery.