Effective Treatment of Refractory Peritonitis Caused by Klebsiella pneumoniae Using Personalized Bacteriophage Therapy in a Peritoneal Dialysis Patient: Case Report and Review of Published Literature

Phage therapy is emerging as a promising alternative to antibiotics for treating various infections. However, there have been no prior studies on using bacteriophages for peritonitis in patients undergoing peritoneal dialysis. This report presents the successful treatment of refractory peritonitis in a 71-year-old male peritoneal dialysis patient using bacteriophages. The patient had a history of refractory and repeat peritonitis caused by Staphylococcus epidermidis, which was resolved through simultaneous catheter replacement (SCR). Subsequently, the patient experienced another episode of refractory peritonitis due to Klebsiella pneumoniae. Although this strain was found to be susceptible to amikacin and imipenem, prolonged treatment with these antibiotics in the abdominal cavity failed to resolve the peritonitis. Combined with antibiotic therapy, the patient was successfully treated with intraperitoneal phage therapy targeting his bacterial isolate. We monitored the longitudinal progression of phage loads, phage-neutralizing antibodies, interleukin-6 levels, and lipopolysaccharide concentrations in the dialysate effluent during the bacteriophage therapy. Our study suggests that personalized phage therapy combined with sensitive antibiotics can play a significant role in managing refractory peritonitis in patients undergoing peritoneal dialysis, showing promise for future applications.