How a Multi-Drug Resistant Bacterium was the cause of death of Mr GJ: A case study in challenges faced in treatment of infections with antibiotics

Mr GJ was a diabetic and had diabetic ulcers in one of his legs. Recently, due to his negligence of diabetic control and the foot wounds, one of the wounds developed into a major ulcer. His family members urged him to consult his physician. Yet he refused to acknowledge the seriousness of the condition. This is because he hated medicines, disliked doctors and hated hospitals. Nevertheless, a family member consulted his physician and on his advise, got a blood test done. The report indicated that he had low sodium and high sugar, and because he was unable to sit and stand, and based on physician's advise, he was hospitalised.

In the hospital, a culture taken from his wound showed infection with drug susceptible Klebsiella species. His treatment began with the appropriate antibiotics (following AST) that involved infusions, thrice a day, for a week. His wound was also regularly dressed. However, on the third day, he suddenly wanted the treatment to be stopped because he wanted to be discharged. Any amount of convincing by the attending doctors, nursing staff and attendants did not help. His family had no choice but to bring him home with the assurance to the doctors that he will take the same antibiotics orally and get his wound dressed regularly.

However, he refused treatment and missed critical doses, while occasionally he took a dose according to his mood and did not allow wound dressing. Over a few days he developed urinary tract infection, with blood in the urine. He was hospitalised again, and put on appropriate antibiotics (following culture and AST) as infusions. Mr GJ began resisting treatment by arguing with the doctors. The doctors somehow convinced him to agree. After 5 days the infection burden was reduced (monitoring by culture). He was discharged with advice to continue the antibiotics for a week. He disobeyed the advice and took the drugs as per his choice missing several doses. His family members tried their best to convince him to take the medicines but of no avail. He was very stubborn and sometimes lost his temper.

Over the next few weeks, he developed complications and became critical. He was immediately hospitalised. The doctors diagnosed severe urinary tract infection and it had entered the blood stream (septicaemia), and the chances of him recovering were low. Mr GJ eventually passed away due to a possible multi-organ infection.

When his urine culture report came, it sent a chill down the spine. The offending bacterium was E.coli which was resistant to virtually all antibiotics that was tested! This organism evolved to become resistant or was selected following the intermittent exposures of the antibiotics over this period of treatment.

Finally, it was a multi-drug resistant infection which was the cause of Mr GJ’s death.

Here is a case of an infection that could have been perfectly cured if the patient had adhered to the treatment. The major challenge here was that in convincing Mr GJ that his condition was bad and needed the treatment to cure his infection and wound. He always maintained that he was perfectly fine and did not think this treatment was necessary. ?This case underscores the challenges faced while treating patients with infections. Secondly, infections of diabetic wounds should be taken seriously and appropriately treated. If left unattended it can lead to gangrene, which was found in GJ’s toe, can eventually lead to amputation to control infection.

I am sharing this example so that it helps in creating awareness in how antibiotics should be appropriately used and how one should be prepared to face difficult situations such as this, and to take decisions for caregivers, families, and other stake holders for handling a patient.

For me, as a drug discovery scientist working in the discovery and development of antibiotics, it was very painful as I failed to convince Mr GJ about the importance of antibiotics and how it could cure him.

Mr GJ was my father.