An experimental antibiotic saves a man’s leg and his life following an aggressive drug-resistant infection.
After his mother’s funeral in Moshi, Tanzania, George Semakula took a walk around the village where he grew up before flying home to Durham, North Carolina. During his walk, George was mugged, was pushed into a ditch and broke his left ankle so badly that the bone protruded.
He was treated locally for 10 days, flown back to the United States and had surgery at Duke University Hospital in Durham. There, doctors scraped infected flesh from the wound and fixed his bone using pins and plates. They also determined the wound was infected with three types of bacteria, and one of them – Acinetobacter baumanii – was resistant to virtually every commercially available antibiotic.
“The infection was spreading fast, and they said if they couldn’t stop it, they would have to amputate my leg,” said George, an independent truck driver who was then 57.
“I have a medical background, but I never imagined that there would be an infection that was so resistant,” said Miriam, George’s wife. “We kept our hopes high, but in the back of our minds, we knew amputation was a possibility, which was pretty scary.”
The infectious diseases specialists who treated George searched worldwide and finally found an antibiotic that worked – cefiderocol, a Japanese experimental drug not yet approved by the U.S. Food and Drug Administration. Because the drug wasn’t commercially available, a “compassionate use” approval had to be secured from FDA. George received three intravenous infusions of cefiderocol every day for four months.
After six surgeries, a muscle flap, fixation of his fracture with an orthopedic plate and four months of antibiotics, there was no sign of the infection, and George was healing well. Originally confined to a bed, he graduated to a wheelchair and then a walker, mostly for balance. Physical therapy twice a week strengthened his ankle, and walks for at least 20 minutes every day helped build his endurance.
“The antibiotic really worked, the infection is gone, and the healing is going well,” said George. “Now I can cook and do laundry, and Miriam and I go out to dinner and parties.”
George was fortunate. With infections caused by aggressive and highly resistant bacteria such as Acinetobacter, there are no guarantees of such a good outcome, said Vance Fowler, MD, MHS, FIDSA, an ID specialist and a professor of medicine at Duke University School of Medicine who treated George.
“Without the antibiotic from Japan, it would have been almost impossible to treat Mr. Semakula,” said Dr. Fowler. “He would have lost his leg, and possibly his life, if the bug had entered his bloodstream. When your best outcome is to lose your leg, that’s not great.”
He said George’s case and many others underscore the importance of supporting the development of new antibiotics. Increasingly, ID doctors are seeing infections that are either untreatable or are treatable only with antibiotics that come with major side effects.
“Infectious diseases doctors are seeing infections such as these in the United States daily, some coming from exotic points of origin, but many homegrown,” said Dr. Fowler. “Staying a step ahead of these infections requires a multipronged solution, including careful stewardship of our remaining antibiotic resources and providing incentives to pharmaceutical companies to be sure they stay active in antibiotic development.”
Antibacterial development currently is on life support, he said. Many pharmaceutial companies doing this work have abandoned antibacterial development, declared bankruptcy or announced massive layoffs.
“As Mr. Semakula’s case shows, antibiotics underpin modern medicine, and the fact is we desperately need new ones,” Dr. Fowler said.