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Case Reports
. 2015 Oct 10;2015(1):281-8.
doi: 10.1093/emph/eov025.

Clinical management of resistance evolution in a bacterial infection: A case study

Robert J Woods  1 , Andrew F Read  2
Affiliations
Case Reports

Clinical management of resistance evolution in a bacterial infection: A case study

Robert J Woods et al. Evol Med Public Health. .

Abstract

We report the case of a patient with a chronic bacterial infection that could not be cured. Drug treatment became progressively less effective due to antibiotic resistance, and the patient died, in effect from overwhelming evolution. Even though the evolution of drug resistance was recognized as a major threat, and the fundamentals of drug resistance evolution are well understood, it was impossible to make evidence-based decisions about the evolutionary risks associated with the various treatment options. We present this case to illustrate the urgent need for translational research in the evolutionary medicine of antibiotic resistance.

Keywords: Enterobacter; MRSA; antibiotic resistance; clinical decisions; evolutionary risk; resistance management.

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Figures

Figure 1.
Figure 1.
Schematic of a left ventricular assist device (LVAD) in situ, with driveline to external power source. CT scans of the patient revealed evidence of bacterial build up around the efferent limb of the LVAD and the anastamosis to the ascending aorta. The presumed route of invasion was the drive line. Reproduced from http://www.heartware.com/media-resources with permission.
Figure 2.
Figure 2.
The patient’s course from initial signs of LVAD driveline infection through death. Bars in blue show administration of drug, vertical pink lines the timing and duration of hospital visits and the symbols show levels of resistance to the various antibiotics of MRSA (squares) and Enterobacter (circles) isolates taken at various time points, where green is defined as susceptible, yellow is intermediate susceptibilities, and red is resistance. MIC were measured with Vitek or E-test and cutoffs were standard CLSI break points. Drug names in bold can only be given intravenously for this infection. Asterisk shows the timing of the clinical decision discussed in the main text
See this image and copyright information in PMC

References

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