Breast Cancer Problem

Question

A 45 year-old woman complaining of breast pain was diagnosed with having HER2-positive breast cancer. The patient underwent lumpectomy followed by a period of chemotherapy including adjuvant treatment. Over the course of their treatment, the patient developed a urinary tract infection that required antimicrobial therapy, which initially consisted of a trimethoprim/sulfametoxazole combination drug. However, the patient during the course of her therapy suffered multiple recurrent infections and was, consequently, enrolled in a clinical trial to test the efficacy of a new mannoside anti-infective agent.

Question: Discuss the roles of the three components of the patient’s treatment for her relapsing UPEC infection. Your discussion should include the pertinent virulence factors that contribute to the establishment of the infection and the initial treatment failure.

Answer 1

1. Anatomical Difference & Physiological Change: Short urethra=increased risk of UTI's in women, due to the bacteria having a shorter distance to travel in order to cause infection. This patient is also undergoing chemotherapy, which can lead to an immunocompromised state: as cancer cells are destroyed, some healthy cells may also be destroyed...reducing immune system function (physiological change).
2. Antibiotic Resistance: The patient's continued use of Bactrim (trimethoprim/sulfamethoxazole) and UTI's that keep recurring could indicate possible resistance- remember, continued use of the same antibiotic over a longer period of time can lead to antibiotic resistant organisms.
3. A culture and sensitivity (C&S) should be performed to find an antibiotic that the organism will respond to (one that will kill the organism)
4. Virulence Factors of Organism: Her UPEC (urinary tract infection caused by E. Coli) contains multiple virulence factors that allows it to thrive. For example, FimH allows E. Coli to adhere to the urinary tract, which makes it more difficult for the bacteria to be excreted in the urine.