Demetrios, a 40 year-old husband and father, is a survivor. His story is a testament to the courage that lives at UHN.
In 1995, Demetrios was a healthy young man working in retail. His life changed when he was diagnosed with Hodgkin's Lymphoma, a form of cancer. Although Demetrios won his battle with cancer, his treatment weakened his heart considerably, and in 2006, he was diagnosed with a type of heart disease known as cardiomyopathy.
A struggling heart
By 2009, Demetrios' heart could no longer function on its own. He required a left ventricular assist device (LVAD), a mechanical pump implanted in his chest to help pump blood throughout his body – a bridge to receiving a heart transplant.
Unfortunately, his LVAD became infected with a bacteria known as Pseudomonas aeruginosa (Ps. aeruginosa), a common cause of hospital-acquired infections naturally resistant to many antibiotics. Ps. aeruginosa is able to adapt and survive when exposed – even to the few antibiotics known to treat this germ. Therefore, antibiotics with activity against Ps. aeruginosa are avoided to avert development of further resistance.
For Demetrios, there wasn't a choice. To treat his Ps. aeruginosa infection, strong antibiotics were required to save his life. For two and a half years, Demetrios battled multiple Ps. aeruginosa infections of his LVAD. If the germ became resistant to these antibiotics, there would be no treatment options left to save his life.
"Demetrios' story is an example of how antimicrobials are precious and should only be used when patients really need them," said Dr. Andrew Morris, Medical Director, Antimicrobial Stewardship Program.
To help maintain this delicate balance, advice was sought from Dr. Shahid Husain, Antimicrobial Stewardship and Transplant Infectious Diseases physician at UHN.
"Dr. Husain played a significant role during my hard times," said Demetrios. "I owe my life to him, his team and the heart transplant team at Toronto General Hospital."
The gift of life
In March 2012, Demetrios received the gift of life: a heart transplant at UHN. However, there wasn't much time for Demetrios to breathe a sigh of relief – after the heart transplant, the medications needed to prevent his body from rejecting the new heart weakened his immune system and his Ps. aeruginosa infection returned with a vengeance.
Husain and Demetrios' care team were faced with the difficult challenge of keeping the balance between reserving antibiotics for when he really needed them, and treating the infection to save his life.
Demetrios fortunately responded to therapy and at least for the moment, the Pseudomonas infection was gone.
Baby on board
After several months of hospitalization, Demetrios returned home and life resumed.
"I experienced the greatest joy of my life: my son was born," said Demetrios. "This was something I didn't know could have been possible when I started my journey with heart failure."
Demetrios' condition remained stable until late 2012, when he began to develop fever, shivers and diarrhea. He was admitted to the hospital and diagnosed with Clostridium difficile (C. difficile) infection.
C. difficile, a bacterium causing mild to severe diarrhea and inflammation of the colon, can be fatal.
It's the most frequent cause of infectious diarrhea in hospitals in Canada. Most cases occur in patients taking antibiotics in high doses or over a prolonged period of time. Antibiotics can destroy a person's normal bacteria found in the gut, causing
C. difficile bacteria to grow. When this occurs, the bacteria produce toxins, which can damage the bowel and cause diarrhea.
The very antibiotics being used to treat Demetrios' life-threatening Ps. aeruginosa infection were also making him vulnerable to C. difficile. Over the next several months, Demetrios was plagued with recurrent C. difficile infections, leaving him tired with little energy for tasks of day-to-day living.
But Demetrios didn't give up. His doctors prescribed antibiotics appropriately to treat his C. difficile infection, and reserved antibiotics active against Ps. aeruginosa for when he truly needed them. This allowed him to recover and eventually the infection resolved.
"Antimicrobials can be lifesaving, but they can also make patients like Demetrios sick with C. difficile infection and other adverse effects," said Morris. "As advances in medicine allow us to do more to keep patients alive, they become more vulnerable to infection – and treating those infections (when they occur) aggressively will also help keep patients alive." The beat goes on
Most of this now seems like a distant memory to Demetrios.
"Through the grace of God and the support of my loving wife, family and friends, I have conquered these infections," said Demetrios.
Today, Demetrios is a stay at home Dad, with a full-time job of raising his son.
"Watching my son grow has been amazing – every day I spend with him is a blessing. It is the best job in the world," said Demetrios. "Miracles do happen. I see it every day in my son's eyes".
Nov.18-22 is Antibiotics Awareness Week. Learn more about the UHN-MSH Antimicrobial Stewardship Program.
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