Case 16

Patient #16, a 45-year-old woman who underwent a liver transplant leading to septic shock from intra-abdominal infection. She underwent liver transplantation in April 2019 which was complicated by delayed closure, biliary leak, peritonitis, and ischemic bowel s/p multiple resections. Her abdomen was closed using mesh which developed DIC and bleeding. This infection was colonized with Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterococcus faecium. The VRE was addressed with an antibiotic regimen and the patient received two phage P. aeruginosa and Klebsiella. The patient had noticeable improvement after the first few doses of the P.aeruginosa phage, but this improvement was overshadowed after the administration of the second phage. Observed phage interactions within the HRQT suggests that the K. pneumoniae phage inhibited the P.aeruginosa phage from attacking the patient bacteria. The patient was moved to comfort care after she suffered multiple system organ failure.