PMC10319284_01
Chest CT scan just after transplant (A) and at one-year post-transplant (B). Chest CT scan showed normal bronchi and parenchyma after transplant (A). At one-year post-transplant, the imaging shows diffuse airway wall thickening, bronchiectasis, mucus plugging, and some sub-bronchial consolidations (B) related to chronic bronchopulmonary infection.
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After transplant, the patient rapidly developed severe recurrent bronchopulmonary infections due to Pseudomonas aeruginosa despite several repeated associative antibiotic therapies and continuous inhaled colistin (Figure 1, description of the clinical course and therapies). The patient's respiratory function progressively deteriorated (obstructive pattern) leading to severe chronic respiratory failure requiring oxygen supplementation associated with recurrence of bronchiectasis on chest CT scan (Figure 1). 
Clinical course and therapies to treat the Pseudomonas aeruginosa bronchopulmonary infection within the two years post-transplant.
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We enhanced the immunoglobulin supplementation with IgM/IgA-enriched immunoglobulins (Pentaglobin , Biotest, Dreieich, Germany), Figure 2. 
Phagogram performed with the Pseudomonas aeruginosa strain isolated in the sputum in June 2021. Bacterial growth was recorded over time (x-axis) by optical density at 600 nm (OD600nm, y-axis). The impact of each phage on bacterial growth was evaluated at seven different doses. For phage, PP1450, PP1792, and PP1797, the highest phage dose (8Log PFU/mL) led to decreased bacterial density compared to the control without phage. By comparison, phage PP1777 had no impact on the bacterial density whatever the dose was.
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Manufacturing Practices (GMP) and that were available as ready-to-use by the company, PP1450, PP1792, and PP1797 have shown activity on the patient's strains (Figure 3). Multisite samples revealed the presence of the XDR Pseudomonas aeruginosa in the stool and the nose.
Phage and antibiotic therapies to treat the Pseudomonas aeruginosa bronchopulmonary infection performed in September and October 2021.
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For that reason, we associated inhaled phage therapy (2 inhalations a day using vibrating mesh, Aeroneb , Aerogen, Galway, Ireland) and oral ingestion of phages 2 times a day for 7 days (Figure 4).   Thus, we associated these antibiotics with the BT, Figure 4.