Background Non-tuberculous Mycobacterium (NTM) infections, particularly Mycobacterium abscessus, are increasingly common among patients with cystic fibrosis and chronic bronchiectatic lung diseases. Treatment is challenging due to intrinsic antibiotic resistance. Bacteriophage therapy represents a potentially novel approach. Relatively few active lytic phages are available and there is great variation in phage susceptibilities among M. abscessus isolates, requiring personalized phage identification. Methods Mycobacterium isolates from 200 culture-positive patients with symptomatic disease were screened for phage susceptibilities. One or more lytic phages were identified for 55 isolates. Phages were administered intravenously, by aerosolization, or both to 20 patients on a compassionate use basis and patients were monitored for adverse reactions, clinical and microbiologic responses, the emergence of phage resistance, and phage neutralization in serum, sputum, or bronchoalveolar lavage fluid. Results No adverse reactions attributed to therapy were seen in any patient regardless of the pathogen, phages administered, or the route of delivery. Favorable clinical or microbiological responses were observed in 11 patients. Neutralizing antibodies were identified in serum after initiation of phage delivery intravenously in eight patients, potentially contributing to lack of treatment response in four cases but were not consistently associated with unfavorable responses in others. Eleven patients were treated with only a single phage, and no phage resistance was observed in any of these. Conclusions Phage treatment of Mycobacterium infections is challenging due to the limited repertoire of therapeutically useful phages, but favorable clinical outcomes in patients lacking any other treatment options support continued development of adjunctive phage therapy for some mycobacterial infections.

Cystic fibrosis is associated with significant morbidity and early mortality due to recurrent acute and chronic lung infections. The chronic use of multiple antibiotics without pathogen eradication increases the possibility of extensive drug resistance or even pan-drug resistance (PDR). It is imperative that new or alternative treatment options be explored. We present a clinical case of a 10-year-old female cystic fibrosis patient, infected with a PDR Achromobacter spp. She was treated with cefiderocol, meropenem/vaborbactam, and bacteriophage therapy (Ax2CJ45ϕ2) during two se

Treatment options for Achromobacter xylosoxidans are limited. Eight cystic fibrosis patients with A. xylosoxidans were treated with 12 cefiderocol courses. Pre-treatment in vitro resistance was seen in 3/8 cases. Clinical response occurred after 11/12 treatment courses. However, microbiologic relapse was observed after 11/12 treatment courses, notably without emergence of resistance.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, complex, idiosyncratic drug reaction that can be fatal. Systemic symptoms include lymphadenopathy, hepatic failure, and possibly renal failure. The syndrome has been primarily associated with anticonvulsants, whereas antimicrobials are less commonly associated. We describe a 63-year-old woman who initially presented with rash and acute kidney injury secondary to treatment with clindamycin for a methicillin-susceptible Staphylococcus aureus prosthetic hip infection. Her rash progressed to desquamation of over 90% of her body surface area. Her renal function progressively declined during her hospital stay, and continuous renal replacement therapy was started. Peripheral eosinophilia was present, and urine studies were consistent with intrinsic renal failure. The patient also developed pancreatitis, hepatic failure with elevated liver enzyme levels and coagulopathy, respiratory failure necessitating mechanical ventilation, and hypotension. After a 16-day hospitalization, life-sustaining measures were withdrawn, and the patient died. Use of a cutaneous adverse drug reaction scale indicated that clindamycin was the definite cause of this patient's DRESS syndrome. To our knowledge, this is the first case report of fatal clindamycin-induced DRESS syndrome and only the second case report of DRESS attributable to clindamycin therapy. Although commonly linked with anticonvulsants, clinicians should consider the possibility of this reaction with antimicrobials, including clindamycin.