Citations

Background: Prosthetic joint infections (PJIs) pose a significant treatment challenge due to biofilm-associated resistance, which limits antibiotic effectiveness. Bacteriophages, naturally occurring viruses that selectively infect and lyse bacteria, can disrupt biofilms, potentially enhancing antibiotic activity. We present the case of a male in his 70s with a history of total hip arthroplasty in 1973 who developed a chronic methicillin-susceptible Staphylococcus aureus (MSSA) PJI. Despite eight surgical interventions and multiple courses of suppressive antibiotics, the infection persisted, necessitating the use of bacteriophage therapy. Methods: The patient's MSSA isolate was sent to a bacteriophage laboratory in Quebec, which identified effective bacteriophages, and a two-bacteriophage cocktail was selected. Following approval by Health Canada and the University of Calgary (REB23-1733), bacteriophages were administered during a planned incision and drainage (I&D). Locally, bacteriophage was applied topically into the hip, followed by 2 weeks of twice-daily intravenous bacteriophage therapy with standard-of-care intravenous antibiotics. Results: Therapy was well tolerated except for initial mild rigors. Now, 24 weeks after bacteriophage administration, there is cessation of pain, normalization of inflammatory markers, and significant improvement in quality of life while continuing on suppressive antibiotics. Conclusions: Bacteriophage therapy was safe in our case, and emerging evidence is promising for its use in PJIs. However, regulatory hurdles, cost, and lack of standardized protocols currently limit its use. Classified as experimental therapy in Canada, bacteriophage use is restricted to clinical trials. This case underscores the potential for broader adoption of bacteriophage therapy in managing PJIs across Canada.

Background: To evaluate the safety of Aliya pulsed electric field (PEF) ablation in lung lesions at the time of biopsy before first-line standard of care (SOC) therapy in patients with metastatic cancer. Methods: Eligible patients requiring diagnostic biopsy for suspected metastatic lung lesions were enrolled. Treatment-naive lesions ≤5 cm were PEF ablated bronchoscopically or percutaneously. Procedure and/or device-related adverse events (AE) or serious adverse events (SAEs) and their effects on subsequent therapy were assessed from PEF ablation through 30 days. Results: Forty-four lesions from 30 enrolled patients were ablated using PEF with 3-dimensional image guidance immediately following diagnostic biopsy under general anesthesia. Ninety percent (27/30) were ablated bronchoscopically with robotic navigation. One to 3 lesions (range: 0.4 to 2.4 cm longest diameter) were ablated per patient, including 17 within 1 cm of the pleura or a fissure. One procedure-related SAE (pneumothorax) occurred at the time of percutaneous biopsy and PEF ablation and resolved without sequelae. No AE impacted planned therapy initiation. Limited changes to the lung parenchyma in and around the PEF ablation zone were observed on CT scans 30 days post-PEF ablation. Conclusion: This study demonstrates PEF ablation of lung lesions at the time of diagnostic biopsy is safe. One PEF-related SAE occurred within 30 days of PEF and resolved without sequelae. Ablation adjacent to sensitive structures was feasible, safe, and without impact on subsequent therapy.

Abstract Background: Peripheral Blood Progenitor Cells (PBPC) cryopreserved in DMSO are thawed at the patient’s bedside and infused immediately. Usually the infusions are completed without incident. There are occasions when mild/severe transfusion related reactions occur. When this does occur, the infusion is either slowed or paused for a short period of time. When reactions are severe enough to warrant stoppage of the infusion, transplant facilities maybe faced with discarding any remaining thawed cells. We have explored the question of salvaging the remaining cells by re-cryopreservation using two cryopreservation methods. Study Design: Twenty PBPC were thawed in a 37C water bath until the internal temperature of the cells was approx 2-6C. The PBPC were not washed and allowed to remain at room temperature for 15 minutes. Ten PBPC were then placed on ice for 45 minutes. This simulated the transfer of cells to an off-site cryopreservation lab. These cells were then transferred to a new cryo bag, no change in the cryoprotectant solutions, and placed into a rate controlled freezer (RCF) bringing their temperature back to <−160C. The remaining 10 PBPC were allowed to remain at room temperature for an additional 10 minutes. The PBPC were then transferred to a −80C mechanical freezer. This simulated the transfer of cells to an internal laboratory without cryopreservation capabilities. All 20 PBPC were thawed after a minimum of 24 hours after return to their respective storage freezer conditions. We measured total nucleated cell count, viability by trypan blue, and CFU after the initial thaw and after the second thaw. Results: The median viability of all PBPC after the first thaw was 69.5% (n=20; range= 35–83%). The median post thaw viability of the PBPC frozen by the RCF was 55.5% (n=10; range= 18–73%). Whereas, the median post thaw viability of the PBPC frozen in the −80C freezer was 25% (n=10; range 8–37%). Additionally, the median percent of viable cell loss from the initial pre-freeze data to the second thaw data for the RCF PBPC was 66.1% (n=10; range= 0 – 94.6%) and for the −80C PBPC was 94.1% (n=10; range= 91.3–97.8%. CFU growth was present for the RCF PBPC. No growth was demonstrated for the −80C PBPC. Conclusion: Though neither method provided outstanding results, if faced with the dilemma of losing cells or attempting to save by re-cryopreservation, a transplant facility should consider RCF over −80C freezing.