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Patient Stories: Roger Poser

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A man from Texas undergoes combination antibiotic therapy to combat an extremely antibiotic-resistant strain of Pseudomonas.

In July 2015, Roger had successful surgery for his lung cancer. His wife, Marsha, recalls that a week after surgery, doctors mentioned that Roger’s white blood cell count (a marker of infection) was rising slightly, but they weren’t worried. Roger felt fine and was looking forward to going home. He’d had the same procedure on his other lung the year before and recovered without problems. 

Before he left the hospital, the infectious diseases team took a sample from his lung to check for infection, and the culture was positive for the Pseudomonas bacterium. He had trouble breathing, and his white blood cell count rose, a sign he was fighting infection. He was started on broad-spectrum antibiotics, but worsened, went into respiratory failure and was moved to the intensive care unit (ICU). 

Roger was too ill to undergo tests to determine the cause of his respiratory distress. Doctors told Marsha he was unlikely to survive. While in the ICU he went into cardiac arrest and was rushed into surgery. His white blood cell count continued to rise as the infection spread. Roger had a CT scan that revealed a large amount of bleeding near the bottom of Roger’s lung due to the Pseudomonas infection, which also was hindering his heart and lung function. 

Doctors kept him stable overnight and the area was sprayed with antibiotics to prevent re-infection.

Three weeks after surgery, Roger’s white cell count remained unstable. Doctors determined some stitches from his lung surgery had loosened. His lungs continued to lose function, so he was placed on a respirator. Doctors suspected the bacteria were following the tubes in his lungs. Roger moved to another hospital and had an experimental procedure to place valves in his lungs.

After two months in the hospital, Roger was taken off the respirator and doctors focused on curing the infection. Infectious diseases physician Dr. Clare Gentry – who Roger and Marsha credit with saving his life –determined he was infected with an extremely antibiotic-resistant strain of Pseudomonas. Doctors began to fear they would not find a combination of antibiotics that could control the infection, and they would have to do extremely risky surgery to remove all of the infected tissue from inside his chest. 

Dr. Gentry prescribed ciprofloxacin, which was temporarily holding the infection at bay. Dr. Gentry suggested Zerbaxa®, a combination antibiotic therapy that was not FDA-approved to treat pseudomonas but had shown promising test results. Because Zerbaxa® is very difficult to obtain, Roger was put on a waiting list. Several weeks passed, and his infection became increasingly resistant to the ciprofloxacin. Finally, doctors obtained the Zerbaxa®. Within one day of treatment, Roger’s white blood cell count dropped dramatically and approached the normal range. Doctors remained skeptical about Roger’s recovery as his infection could develop a resistance to Zerbaxa® as well. But his white blood cell count continued to improve, so Dr. Gentry tapered him off the Zerbaxa® to see if the infection would return. It did not, and Roger was able to go home, nearly four months after his initial surgery. He has recovered, with no signs of re-infection. Roger’s immune system was severely weakened after extended courses of antibiotics, and he has been briefly readmitted to the hospital several times for minor illnesses. But he recently overcame a cold on his own without being hospitalized.

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