Case 20

Patient #20 was a 10 year-old female with an inherited genetic dilated cardiomyopathy and had a Berlin heart inserted in January 2019. She had a prolonged hospital course that included colonization with Klebsiella pneumoniae and Pseudomonas aeruginosa, Clostridum difficile toxin-associated colitis and almost persistent bacteremia with P. aeruginosa. She recieved seven weeks of a single bacteriophage therapy intravenously and meropenem. She had a decline in her health while on treatment and experineced high fevers and decreased level of consciousness and both phage ane merepenem were discontinued. Alhough her daily cultures were negative and inflammatory markers remained within normal limits, phage and meropenem therapy was stopped due to high fever and major reduction in neurological response. After discontinuation of therapy, her cultures were positive for MDR P. aeruginosa and had the same antibiotic susceptibilities as her original cultures. Due to low consciousness level, with no known source of her resistant infection, failure to gain weight and tolerate feeds, her parents asked to discontinue suportive therapy and she passed away in January 2020.