Resolving Digital Staphylococcal Osteomyelitis Using Bacteriophage-A Case Report

Abstract

Infections involving diabetic foot ulcers (DFU) are a major public health problem and have a substantial negative impact on patient outcomes. Osteomyelitis in an ulcerated foot substantially increases the difficulty of successful treatment. While literature suggests that osteomyelitis in selected patients can sometimes be treated conservatively, with no, or minimal removal of bone, we do not yet have clear treatment guidelines and the standard treatment failure fallback remains amputation. The authors report on the successful treatment, with a long term follow up, of a 63 YO diabetic female with distal phalangeal osteomyelitis using bacteriophage, a form of treatment offering the potential for improved outcomes in this era of escalating antibiotic resistance and the increasingly recognized harms associated with antibiotic therapy.

Keywords: Bacteriophages; Staphylococcus aureus; diabetic foot ulcer; osteomyelitis; phage therapy.

Figure 1

Images of the patient’s ulcer on presentation. (a) Top view of foot. (b) View of ulcer at the distal tip.

Figure 2

Radiographs of ulcerated toe over the course of treatment showing re-ossification of the toe. (a) Radiograph taken on 20 April 2015. (b) Radiograph taken on 24 July 2015. (c) Radiograph taken on 24 June 2015. (d) Radiograph taken on 22 September 2015. Note areas of re-ossification from photo (a) to photos (b,c) and (d) (arrows).

Figure 3

Progression of healing of the ulcer. (a) Image of ulcer at the distal tip taken on 30 April 2018. (b) Radiograph taken on 30 April 2018. (c) Image of closed ulcer at the distal tip taken on 8 May 2018.