Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

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Mariana Bridi da Costa, a 20-year old Brazilian model, tragically died early Saturday morning from Pseudomonas aeruginosa urosepsis.

How can this happen?

Miss Bridi da Costa initially presented on December 30th, and was diagnosed with kidney stones. An ultrasound, plain film, or CT scan likely would have been done to confirm the diagnosis. I assume that a urinalysis was also performed, and if so, may have pointed to a urinary tract infection on that day.

Treatment of kidney stones typically consists of fluids and pain control. Depending on the size and location, a urologist may need to be consulted to extract the stone via a procedure, or break it up with shock waves. Antibiotics are normally not prescribed in uncomplicated cases.

In any case, she was apparently sent home, and presented again on January 3rd in septic shock. This is a condition involving life-threateningly low blood pressure brought about by an infection that has spread to the bloodstream.

Patients in this scenario are critically ill, requiring intravenous medications to maintain the blood pressure, and several broad-spectrum antibiotics to treat the infection. In Miss Bridi da Costa’s case, the responsible bacteria was Pseudomonas aeruginosa.

On January 23rd, it was reported she had to have her hands and feet amputated, presumably from continued spread of the infection. She passed away days later.

Pseudomonas aeruginosa is one of the most virulent bacteria that exists. It is resistant to many antibiotics, and can rapidly mutate to become resistant to newer drugs. Normally, more than one antibiotic has to be prescribed to ensure its eradication.

It is almost always contracted within the hospital, causing about 10 percent of the two million hospital-acquired infections each year in American hospitals. The presence of a urinary catheter or undergoing urologic procedures – such as a cystoscopy – can lead to Pseudomonas-associated urinary tract infections.

In this case, the fact that the infection was caught within the community is worrisome, and exceedingly rare. Assuming that she was not immunocompromised, she may have had previous colonization with the Pseudomonas in her genitourinary tract. Bacteria then could have ascended through the urethra to the kidneys, and from there, into the blood stream.

Once in the blood, infection that remains untreated causes a significant inflammatory response, leading to possible blood clots, or results in the blood vessels within the extremities to shut down, causing the tissue to become necrotic. Amputation would then be necessary.

I suspect that earlier treatment, such as when she initially presented on December 30th, may have made a difference. Ciprofloxacin, a common antibiotic used to treat urinary tract infections, does have activity against Pseudomonas. By the time she presented with sepsis, her prognosis became exceedingly poor, with studies showing up to a 40 to 50 percent mortality rate.

Although most infectious disease specialists acknowledge that contracting a Pseudomonas infection outside the hospital is not common, this is a sobering reminder that drug-resistant infections are not only possible, and may be on the rise. We are already seeing an increase in the number of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile cases within the community.

Inappropriate antibiotic use is a major culprit, but it’s a problem that’s often dismissed. So the next time you go to the doctor’s office thinking you need an antibiotic for a cold, think of Mariana Bridi da Costa.

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