Evidence map›Paper›PMID 41513696›Full record

ArticleNature communications2026

Timely bespoke phage-antibiotic combination to treat refractory Pseudomonas aeruginosa mediastinitis and vascular graft infection.

Shimin Jasmine Chung, Yang Liu, Shuhua Thong, Yang Zhong, Zhi Soon Chong, Zhining Lim, Sabrina Tan, Jia Hao Yeo, Ming Guang Koh, Nathalie Grace Sy Chua and 17 more

Abstract readCase Reports
In one paragraph

Article in Nature communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. From screening to treatment:Microbiology spectrum · 2026
    Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Shimin Jasmine Chung *Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.ORCID http://orcid.org/0000-0002-5174-7361
Yang Liu *Division of Pharmacy, Singapore General Hospital, Singapore, Singapore.ORCID http://orcid.org/0000-0002-8102-7218
Shuhua ThongDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.
Yang ZhongDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.
Zhi Soon ChongDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.ORCID http://orcid.org/0009-0002-8990-8471
Zhining LimSingapore Centre for Environmental Life Science Engineering (SCELSE), Nanyang Technological University (NTU), Singapore, Singapore.
Sabrina TanSingapore Centre for Environmental Life Science Engineering (SCELSE), Nanyang Technological University (NTU), Singapore, Singapore.
Jia Hao YeoDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.ORCID http://orcid.org/0000-0001-6478-5888
Ming Guang KohSingapore Centre for Environmental Life Science Engineering (SCELSE), Nanyang Technological University (NTU), Singapore, Singapore.
Nathalie Grace Sy ChuaDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.ORCID http://orcid.org/0000-0003-2416-300X
Dorothy Hui Lin NgDepartment of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
Winnie Hui-Ling LeeDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.
Tze Peng LimDivision of Pharmacy, Singapore General Hospital, Singapore, Singapore.
Limin WijayaDepartment of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
Boon Huan TanResearch Laboratory Division, Communicable Diseases Agency, Singapore, Singapore.
Peng Huat Eric YapLee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Thet Tun AungOcular Infections and Anti-Microbials Research Group, Singapore Eye Research Institute, Singapore, Singapore.
Rick Twee-Hee OngSaw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Karrie Kwan Ki KoSingHealth-Duke-National University of Singapore Medical School, Academic Clinical Programme (Pathology), Singapore, Singapore.ORCID http://orcid.org/0000-0002-5968-1870
Tse Hua Nicholas WongSingHealth-Duke-National University of Singapore Medical School, Academic Clinical Programme (Pathology), Singapore, Singapore.
Yu Lin Charlene TangDepartment of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore.
Yee Jim LohDepartment of Cardiothoracic Surgery, National Heart Centre, Singapore, Singapore.
Teing Ee TanSingHealth Duke-NUS Transplant Centre, Singapore, Singapore.
Thuan Tong TanDepartment of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
Sandra KolundzijaSingapore Centre for Environmental Life Science Engineering (SCELSE), Nanyang Technological University (NTU), Singapore, Singapore.
Wilfried MoreiraSingapore Centre for Environmental Life Science Engineering (SCELSE), Nanyang Technological University (NTU), Singapore, Singapore. wilfried.moreira@ntu.edu.sg.
Andrea Lay-Hoon KwaSingHealth-Duke-National University of Singapore Medical School, Academic Clinical Programme (Medicine), Singapore, Singapore. andrea.kwa.l.h@sgh.com.sg.ORCID http://orcid.org/0000-0001-8981-4411

Funding

MOH | National Medical Research Council (NMRC) CG21APR1011MOH | National Medical Research Council (NMRC) CG21APR2005MOH | National Medical Research Council (NMRC) MOH-000018-00MOH | National Medical Research Council (NMRC) MOH-000957MOH | National Medical Research Council (NMRC) MOH-001168-00MOH | National Medical Research Council (NMRC) MOH-001278-01MOH | National Medical Research Council (NMRC) MOH-OFIRG21jun0038MOH | National Medical Research Council (NMRC) MOH-OFYIRG25jan-0007
6 · The paper itself

Abstract

Biofilm-related vascular graft infections (VGIs) pose major therapeutic challenges due to persistent, antibiotic-resistant bacteria often residing in retained grafts. Phage therapy offers a promising alternative treatment strategy against biofilm-associated infections, though its use remains mostly ad hoc and typically considered a last-resort intervention. We report here the treatment of a refractory, fluoroquinolone non-susceptible Pseudomonas aeruginosa VGI using a systematically planned and synergistic phage-antibiotic combination approach. Adjunctive phage therapy led to radiological improvement, as seen by reduced 18F-FDG PET/CT tracer uptake around the graft. The patient was transitioned to oral fluoroquinolone suppression therapy with no recurrence of bacteremia to-date, after a year. Our workflow led to the selection of phages that sensitized Pseudomonas aeruginosa to killing by levofloxacin and piperacillin-tazobactam. We established that this phage-driven antibiotic sensitization was due to the ability of our phages to use the MexAB-OprM efflux pump as a receptor. We also showed that our phages had potent anti-biofilm activity. We advocate a systematic, multi-pronged management strategy for refractory VGIs, including early therapeutic drug monitoring (TDM), in vitro antibiotic combination testing (iACT), and timely adjunctive phage therapy. This case illustrates the utility of individualized, strategic approaches and highlights adjunctive phage therapy's potential in treating complex biofilm-related infections.

Indexed as

Anti-Bacterial AgentsMediastinitisPhage TherapyProsthesis-Related InfectionsPseudomonas aeruginosaPseudomonas InfectionsPseudomonas PhagesBacterial Outer Membrane ProteinsBiofilmsBlood Vessel ProsthesisHumansLevofloxacinMembrane Transport ProteinsPiperacillin, Tazobactam Drug CombinationAnti-Bacterial AgentsBacterial Outer Membrane ProteinsLevofloxacinMembrane Transport ProteinsMexA protein, Pseudomonas aeruginosaMexB protein, Pseudomonas aeruginosaOprM protein, Pseudomonas aeruginosaPiperacillin, Tazobactam Drug Combination

Identifiers

PMID41513696
PMCPMC12877064

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.