In 2006, Krupal Shah, a 32-year-old wife and mother, was diagnosed with autoimmune hepatitis.
In the summer of 2010, Shah was working for the YMCA daycare. She started to feel tired often, had little appetite and was beginning to lose weight. As first, she attributed these symptoms to her busy job, but when she began to develop fevers and jaundice, she went to her family physician who directed her to the hospital.
A second diagnosis
In fall 2010, Shah was diagnosed with Primary Sclerosing Cholangitis, a type of liver disease. Due to the severity of her disease, Shah would require a new liver and was placed on the organ transplant list.
During this time, Shah began to experience recurrent fevers. Her doctors diagnosed her with Spontaneous Bacterial Peritonitis, an infection in the abdominal cavity which in Shah's case, was due to the large fluid collection forming in her abdomen caused by her failing liver. Doctors started intravenous ceftriaxone, an antibiotic that treats bacteria commonly responsible for this type of infection.
Despite appropriate antibiotics, Shah continued to battle recurrent fevers that were sometimes over 40 degrees Celsius.
"At first my fevers improved, but then the antibiotics stopped working", said Shah.
This was concerning to doctors as her liver function continued to deteriorate. She was in need of a transplant to save her life. To safely perform the operation, the infection needed to be cleared from her body.
Transplant key to survival
Shah's doctors soon learned the bad news. She was infected with a multi-drug resistant strain of Klebsiella pneumonia. This strain was resistant to most existing antibiotics and left very few available treatment options. If the infection couldn't be treated, there was a considerable chance that Shah would not survive.
"Honestly, it was very hard," said Shah. Everyone knew I was dying but no one wanted to talk about it. I hoped and prayed that the antibiotics would work until I could get a transplant."
It was at this time that Shah was seen by her transplant ID physician, Dr. Shahid Husain, a world renowned expert in his field with the UHN-Mount Sinai Hospital Antimicrobial Stewardship program.
Husain explained they needed to clear her infection before the transplant. Due to the nature of the resistant bacteria infecting Shah, it was necessary to start a potent antibiotic known as meropenem, reserved for resistant infections like hers.
"It's judiciously used because we want to save it for truly resistant infections," said Husain. "Over-use could lead to bacterial resistance to this antibiotic -- and then we would really be in trouble."
Shah continued to be monitored closely. Physicians were waiting for the fevers to break so it would be safe to perform her liver transplant surgery.
After several days on intravenous antibiotic, Shah's fevers finally broke.
A winter miracle
In winter 2010, Shah received her miracle. Her infection was finally under control and it was safe to perform her operation.
"I received the best gift I could ever receive," said Shah. "An anonymous living donor"!
Much to everyone's joy, Shah came through her transplant surgery with flying colours.
Unfortunately, about two months after her surgery, Shah experienced another set-back. Her high fevers returned and she became gravely ill. She was admitted to the intensive care unit with septic shock. Blood cultures revealed another multi drug resistant bacterium had invaded Shah's body.
CT findings showed that Shah had multiple abscesses in her abdomen, the likely source of this infection. Over the course of the coming eight months, Shah was in and out of the hospital. She required multiple courses of a strong antibiotic to treat her infection in addition to source control by draining these abscesses.
"I was constantly afraid that the infection was going to develop resistance to the antibiotics," said Shah. "I was thankful that the antibiotics were working, but for how long, we didn't know."
'Antibiotics helped her to get her life back'
Over the course of several months cycling on and off of antibiotics, the infection finally cleared.
"Dr. Husain was wonderful," said Shah. "He knew exactly what to do and he was always so positive."
"Antibiotics helped her to get her life back", said Shah's husband, Niraj.
Krupal Shah: a survivor
Today, Shah is healthy, happy and living at home with her husband and daughter.
"Much of our life during that time was up and down like a roller coaster," said Shah. "I never believed life could be like that."
Shah is thankful for the care she received from her UHN medical team during her stay at the hospital. She's grateful to her doctors who knew how to appropriately use antibiotics.
"Because they used the antibiotics wisely, and saved them for when I really needed them, they worked," said Shah.Nov. 18-22 is Antibiotics Awareness Week. For more information about the Mount Sinai-University Health Network Antimicrobial Stewardship Team, please visit:
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