Use of bacteriophages in the treatment of extensively drug-resistant Pseudomonas aeruginosa septicemia in a patient with acute kidney injury – a case report

Dr Serge Jennes1

1Brussels and Charleroi Burn Wound Center , Seneffe, Belgium

Abstract:

A 62-year-old man was hospitalized for severe abdominal sepsis with disseminated intravascular coagulation, secondary to a diaphragmatic hernia with bowel strangulation. The patient had a prolonged hospital course complicated by gangrene, resulting in the amputation of the lower limbs and two fingers and the development of large necrotic pressure sores on the back. Three months later, the patient was transferred to the burn wound center of the Queen Astrid military hospital for surgical management of the pressure sores. The patient developed septicemia with extensively drug-resistant (XDR), colistin-only-sensitive, P. aeruginosa. Intravenous (IV) colistin and sulfamethoxazole/trimethoprim combination therapy was started. Ten days later, the patient developed acute kidney injury, probably caused by drug-induced acute interstitial nephritis. The patient was in a coma and antibiotic therapy was stopped. Unfortunately, XDR P. aeruginosa septicemia re-emerged with positive hemocultures for three consecutive days. Upon expert advice and informed consent from the patient’s family, IV and topical bacteriophage therapy were initiated under the umbrella of Art. 37 of the Declaration of Helsinki. Fifty ml of purified bacteriophage cocktail BFC1, containing two active P. aeruginosa bacteriophages in sodium chloride 0,9% at a concentration of 107 plaque forming units (PFU) per ml were administered as a 6h IV infusion for 10 days. Wounds were washed with bicarbonate buffer and irrigated with 50 ml BFC1 every 8h for 10 days. Immediately, blood cultures turned negative, CRP levels dropped and the fever disappeared. Kidney function recovered after a few days. Hemodialysis was avoided and no clinical abnormalities related to the application of bacteriophages were observed.


Biography:

Anesthesiologist and intensive care physician, Colonel in the Belgian Defense Medical component, burn specialist for 20 years, 30 articles in peer reviewed journals and books; head of the Charleroi burn center; former head of the Brussels burn center

Secondary triage of one hundred casualties, transfer and treatment of eight casualties from The Colectiv night club fire disaster in Bucharest: the experience of the Brussels Military Burn Center, the tale of a successful European collaboration.

Dr Serge Jennes1

1Brussels and Charleroi Burn Wound Center , Seneffe, Belgium

Abstract:

Objectives:In the aftermath of the Colectiv tragedy on the 30ieth of October 2015, our military burn center received the mission to flight a burn team (B-team) to Bucharest and to accept eight severely burn victims. We would like to share the lessons learned as a burn team and as a burn center from this calamity and EU collaboration.

Methods:We conducted a retrospective study based on patient data and literature review.

Results and discussion:The B-team sent to Bucharest on November the 5th, 2015 performed the secondary triage of 120 casualties in 11 hospitals over 10 hours. The criteria they used for triage, eligibility for air evacuation (AE) and prioritization for evacuation consisted of TBSA burned (TBSAb) > 15%, localization and depth of the burn wounds, ventilation and hemodynamic parameters compatible with AE, tolerance to intrahospital transportation, GCS at the bedside, social and cultural backgrounds. The AE has been performed by the Romanian air force. In Brussels we admitted on postburn day #9, eight severely burn victims: age 15-42 years-old (mean age 28), TBSAb 15-54% (mean TBSAb 34%) and 3 smoke inhalation injuries. We activated our mass casualty disaster plan as preparation for the admission at once of 8 severe burn casualties. None of the patients died. In mass burn casualties disaster in Europe, there is probably the need for a European plan.

Conclusion:This is the story of a successful collaboration between Romania and Belgium. A European response for MBCD has emerged as a consequence of this tragedy.


Biography:

Anesthesiologist and intensive care physician, Colonel in the Belgian Defence Medical component, burn specialist for 20 years, 30 articles in peer reviewed journals and books; head of the Charleroi burn center; former head of the Brussels burn center

Secondary triage of one hundred casualties, transfer and treatment of eight casualties from The Colectiv night club fire disaster in Bucharest: the experience of the Brussels Military Burn Center, the tale of a successful European collaboration.

Dr Serge Jennes1

1Brussels and Charleroi Burn Wound Center , Seneffe, Belgium

Abstract:

Objectives:In the aftermath of the Colectiv tragedy on the 30ieth of October 2015, our military burn center received the mission to flight a burn team (B-team) to Bucharest and to accept eight severely burn victims. We would like to share the lessons learned as a burn team and as a burn center from this calamity and EU collaboration.

Methods:We conducted a retrospective study based on patient data and literature review.

Results and discussion:The B-team sent to Bucharest on November the 5th, 2015 performed the secondary triage of 120 casualties in 11 hospitals over 10 hours. The criteria they used for triage, eligibility for air evacuation (AE) and prioritization for evacuation consisted of TBSA burned (TBSAb) > 15%, localization and depth of the burn wounds, ventilation and hemodynamic parameters compatible with AE, tolerance to intrahospital transportation, GCS at the bedside, social and cultural backgrounds. The AE has been performed by the Romanian air force. In Brussels we admitted on postburn day #9, eight severely burn victims: age 15-42 years-old (mean age 28), TBSAb 15-54% (mean TBSAb 34%) and 3 smoke inhalation injuries. We activated our mass casualty disaster plan as preparation for the admission at once of 8 severe burn casualties. None of the patients died. In mass burn casualties disaster in Europe, there is probably the need for a European plan.

Conclusion:This is the story of a successful collaboration between Romania and Belgium. A European response for MBCD has emerged as a consequence of this tragedy.


Biography:

Anesthesiologist and intensive care physician, Colonel in the Belgian Defence Medical component, burn specialist for 20 years, 30 articles in peer reviewed journals and books; head of the Charleroi burn center; former head of the Brussels burn center

Lessons identified from the terrorist attacks on March 22, 2016: the experiences of the Brussels military burn centre.

Dr Serge Jennes1

1Brussels and Charleroi Burn Wound Center , Seneffe, Belgium

Abstract:

On the 22nd of March 2016, the burn unit of the Queen Astrid military hospital faced a large influx of victims of the terrorist attacks in the National Airport and the Maalbeek Metro station in Brussels. Twenty-three victims with severe blast- and fragmentation injuries, as well as burns, were assessed and triaged. Eighteen of the 23 assessed casualties were brought directly from the explosion site; five were referred from other hospitals. The burn-specific mortality prediction models predicted a low risk of mortality in our burn patients (1.1 + 2.5%). However, the ISS indicated a significantly higher mortality risk of 10% (average ISS of 16.7 + 17%), due of the multiple blast- and fragmentation injuries. This aside, none of the patients died during hospitalization or during follow up.

The staff of the burn unit turned out to be adequately prepared to cope with this mass casualty incident (MCI). They had been primed through practice during previous MCIs involving burn patients, such as the massive gas explosion in an industrial area in Ghislenghien in July 2004 (132 injured, many suffering severe burns) and more recently (November 2015) the admission of eight severely burned patients from a nightclub fire in Bucharest. With this presentation, we would like to emphasize the importance of patient registration; staff, supplies and infrastructure for triage and treatment; damage control resuscitation and surgery; facilities and staff for debridement and wound care; as well as the importance of drills and training.


Biography:

Anesthesiologist and intensive care physician, Colonel in the Belgium Defence Medical Component, former head of the Brussels burn center and current head of the Charleroi burn center, burn specialist for 20 years, more than 30 articles in peer reviewed papers and books.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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