The havoc resistant bugs can wreak: Mariana Bridi, RIP

Constant readers, you may not have seen this story: It has been moving very fast over the past few days, has now concluded, and is very sad.

Mariana Bridi, a 20-year-old Brazilian who was twice a finalist in her country’s preliminaries of the Miss World competition, died this morning of severe sepsis after a brutal battle that included amputations of her hands and feet.

The bug that caused her death: drug-resistant Pseudomonas aeruginosa. Pseudomonas is a Gram-negative bacterium, and there is a great deal of concern in the infectious disease world about the lack of drugs in the pipeline for Gram negatives.

Bridi apparently had a urinary tract infection. She was initially diagnosed with kidney stones, which she apparently did not have; but the diagnosis suggests she was having sharp pains around the areas of her kidneys or in her lower back, which a UTI can cause if it spreads upward from the bladder. Ascending UTIs are more likely to spill over into the bloodstream, causing bacteremia and triggering sepsis, in which the immune system goes into overdrive in response to the overload of bacteria in the blood. One of the hallmarks of severe sepsis is DIC, disseminated intravascular coagulation, in which micro-clots form in small blood vessels and block circulation, killing the tissue downstream. Sepsis is an extreme emergency; in the past, one-third of people who developed sepsis died, though new modes of treatment have improved those numbers.

What a sad story.

UPDATE: KevinMD.com has an excellent analysis of the case, with contributions from other physicians in the comments. Important point: Pseudomonas is usually a nosocomial organism. If it is correct that Bridi picked up the bug out in her daily life, as opposed to during a prior hospital admission, that would be a very troubling development.

Maryn

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