Case 35

Patient #35 was 84 years old with a past medical history of dementia, hypertension, hyperlipidemia, and obesity who was admitted via the emergency department on 18Jul2020 with acute respiratory failure due Covid19. Chest x-ray showed bilateral atypical infiltrate with fibrotic scarring in the right upper lobe. Cardiac arrest occurred on 01Sept2020. The patient also had a percutaneous endoscopic gastrotomy, tracheostomy, and a large stage 4 sacral wound that required surgical debridement. On 14Sept2020 a sputum culture was positive for CRAB. Phage therapy was started on 27Sept2020 via IV twice a day for 18 days. Sputum cultures were positive for CRAB on 06Oct2020, 09Oct2020, 10Oct2020 and 11Oct2020. A wound culture on 21Oct2020 was positive for CRAB. All blood cultures were negative (9 cultures taken over 3 months from 29Jul2020 to 19Oct2020). Liver enzymes AST/ALT/ALP were elevated on 27Sept2020 prior to phage therapy and increased on 30Oct2020 when phage therapy was discontinued. The maximum values were 193 (AST) on 21Oct2020, 145 (ALT) on 21Oct2020 and 2548 (ALP) on 08Oct2020. The patient expired on 01Nov2020.