Case 40

Patient #40 was 74 years old with a past medical history of chronic lymphocytic leukemia, type 2 diabetes mellitus, arterial coronary sclerosis with non-ST elevated myocardial infarction who presented to the emergency department with respiratory failure due to Covid19. Other complications included septic shock with multi-organ failure, acute kidney injury and hypokalemia. Chest x-ray on 04Sept2020 showed bilateral patchy infiltrates. On 30Sep2020 a sputum culture was positive for CRAB resistant to all antibiotics except tigecycline. Phage therapy was initiated on 06Oct2020 via IV twice a day and was continued for 26 days. Eight sputum cultures were positive for CRAB from 06Oct2020 and 23Oct2020. All 6 blood cultures prior to phage therapy and the 3 following the initiation of phage therapy were negative. No adverse events were reported as related to phage therapy. The AST/ALT/ALP/TB levels were within normal ranges prior to the start of therapy on 06Oct2020. These increased beyond normal values on 01Nov2020, when the patient expired.