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Hospital-acquired Pneumonia case

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T

TJB1054

Guest
What is the name of your state? Virginia

My mother recently went into the hospital for surgery to repair spinal stenosis. She had chronic COPD and asthma and was steroid dependent. In a matter of 36 hours, she passed away from what they later discovered (through an autopsy) was pseudomonal pneumonia.

A couple of things to consider:

--Her temp spiked to 100 degrees just a few hours after surgery and her heart rate climbed consistently from 110 to as high as 150. By the following morning, at 8 a.m., her temp was 102 and her heart rate was still 130.

--She was coughing intermittently through the night.

--She had received prophylactic doses of cephazolin and vancomycin, but did not receive any antibiotics specifically for a gram-negative respiratory infection until 11 a.m. Then she received 500 mg of Levaquin, and not a generally accepted combination antimicrobial therapy for someone at a high risk of pseudomonal infection.

My question is, what burdens do her doctors bear in discovering such a virulent infection before it gets out of hand? Clearly, the infection went very quickly, but they never did give her the proper treatment.
 


ellencee

Senior Member
TJB1054
Your mother's medical/health status is the poster-child of which patients are most likely to develop pseudomonas infections after surgery and fail to recover. I absolutely can not believe a person with chronic COPD, asthmatic, and longterm immunosuppression (from corticosteriods, ie. prednisone), would have or be considered for an elective surgery. Either she would rather have died than to have continued to have back and leg pain or she was facing paralysis, which is unlikely, OR she had an over-aggressive surgeon who failed to sit down and read up on who, if they have surgery, is going to die of pseudomonas. Add to that the highly contraindicated prophylactic broad-spectrum antibiotic regimen and I just don't know what to say; I just can't believe this.

Chances are your mother was host to the pseudomonas infection and the act of entubation and, or surgery propelled the organism into rapid colonization. My bet is on that scenario. For the entubation and, or surgical equipment to have caused the infection, it would have required an incubation period of about 36 hours before the infection became severe.

Once your mother presented with post-op symptoms of an infection, it seems appropriate that the surgeon would have immediately treated the second most common nosocomial infection, pseudomonas. Except, he obviously didn't recognize the risks beforehand, so how can we expect him to recognize the obvious after surgery?

Even if he had begun aggressive, post-op treatment with Levaquin, more likely than not, your mother would not have recovered. Pseudomonas is a most difficult infection to resolve and often requires ventilator support of the patient. Your mother had chronic COPD and asthma! Ventilator support under those conditions is just asking for further trouble.

Whether or not there is a medmal claim depends on several factors. There must be someone, such as a husband, who qualifies to be compensated for her death and the amount of compensation that can be gained must be enough to pay for this expensive lawsuit and still yield compensation to the plaintiff. A medical expert would have to review the records and state, as an expert, that the surgeon knew or should have known that your mother would suffer significant damages.

Medical information is available to the general public, on the web, and defines the patient who will most likely develop pseudomonas and make up the 30-38% of deaths due to nosocomial pneumonia from pseudomonas. Either print some of these articles and take them with you to a medmal attorney or suggest that the attorney take a look at the articles available.

I am truly sorry for the loss of your mother. I am angry over the mechanism of her death.

EC
 

ellencee

Senior Member
I wanted to reactivate this post to add information that relates to hospital acquired infections (nosocomial infections) as this is a topic of concern for many who read this section of the forum or post in this section and because in this OP's described situation, there are several factors that continue to haunt me.

First, the Center for Disease Control and Prevention has mandatory infection control standards and OSHA has mandatory infection control guidelines for ALL healthcare providers. The CDC's standards are more specific than are OSHA's guideline and specifically address the need to identify and consider all patients receiving immunosuppressive therapy as being at significant risk to develop pseudomonas a. pneumonia. When a patient has been identified as being at-risk, the CDC standards specifically state that an antibiotic known to treat the suspected/at-risk infectious organism is to be administered 30 minutes prior to the surgical incision's being made and repeated after three hours if the surgery lasts that long.

Additionally, most hospitals have case-managers whose job is to reduce the number of nosocomial infections through identification of at-risk patients and to interact with all members of the care team to insure that standards and guidelines are met.

It is possible that the surgeon, anesthesist, whoever cleared this woman medically for surgery, the hospital, and the case-manager (RN) are negligent in this poster's described event and such negligence resulted in a nosocomial infection resulting in her mother's death.

Thanks,
EC
 

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