IMMUNOLOGIC ASPECTS OF PHAGE THERAPY OF INFECTIONS RELATED TO MEDICAL CARE IN NEUROREANIMATION

Aim. Evaluate the effect of anti-phage humoral immune response on effectiveness of phage therapy of infections related to medical care (IRMC). Materials and methods. 42 patients on extended mechanical ventilation (MV) in neuroreanimation, 1 time in 2014, 4 times in 2015 and 1 time in 2016 had received bacteriophage cocktail per os - 20 ml including 6 patients - additionally 3-5 times. Effectiveness of phage therapy was evaluated by seeding of IRMC strains from samples of endotracheal aspirate, blood, urine and feces of patients before and after treatment. Results. 87.5% of samples from the patients initially had gram-negative pathogens (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa). Effective sanation for the first episodes of phage therapy was confirmed in 54 - 62.5% of cases. Pharmacokinetic studies have indicated a systemic mechanism of action for enteral forms of bacteriophages. Repeated courses of phage therapy did not result in significant eradication of pathogens. Antiphage immunity after a single administration of the cocktail of bacteriophages with a certain strain composition was detected using ELISA by the presence of specific IgG titers in a range from 1/16 to 1/4096 (in patients not receiving the cocktail antibodies were not detected). Conclusion. Reduction of sanation effect of bacteriophage could be due to formation of anti-phage antibodies after a repeated course in the same patient. Changes of strain composition of phage cocktail of bacteriophages is necessary to preserve results of phage therapy.

bacteriophage, IRMC, antibiotics resistance, humoral immune response, anti-phage antibodies