05/17/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD // (press release)
Multidrug resistant (MDR) Acinetobacter is particularly a dangerous organism in patients who suffer with decubitus ulcers. Populations at risk are the catastrophically injured, the elderly, spinal cord injured, and traumatic brain injured patients.
As a clinician who have directed a wound care program in northeast Louisiana were have provided comprehensive inpatient wound care including myocutaneous flaps management for a referral base of over 100 miles. Over the past four years MDR Acinetobacter and Pan-resistant Acinetobacter species have been showing up in patients referred to our facility. MDR Acinetobacter is an organism resistant to two of the five classes of drugs generally effective against gram negative organism and Pan-resistant Acinetobacter is resistant to all antibiotics.
Most clinicians had little experience dealing with this organism and to compound difficulty in treatment there was little or no best practice articles from the academic centers to guide our treatments. Patients who undergo flap closure for decubitus ulcers require between two to six weeks IV antibiotics following surgery based on the presence or absence of underlying bone infection. Bone infections require six weeks antibiotics. With MDR Acinetobacter there is often only one drug, colistin, which this organism is sensitive to. Four years ago I had never heard of or used this drug because it had been taken off the market in the 1970s because it caused renal failure in 20% of patients. Now I am in a position that I have to use this drug sometimes for extended periods of time. The longer you use the drug, the greater the chance of renal failure. There is also a potential of drug induced acute hemolytic anemia.
Why is this important? Simply this emphasizes that this is a difficult organism to treat because it requires toxic drugs that may harm the patient. All efforts must be expended to prevent a hospital acquired MDR Acinetobacter infection. Any patient who has MDR Acinetobacter must be room confined to a hospital room for their entire stay with isolation precautions to prevent spread to the other vulnerable patient populations. Johns Hopkins takes it one step further in that if you have had MDR Acinetobacter at any prior hospitalizations you will be treated as having MDR Acinetobacter on a subsequent admission. Some hospitals are culturing all ICU patients on admission and placing all patients on isolation until cultures come back negative for a MDR organism.
Outbreaks present a serious health risk to patients and would have disastrous financial implications on hospitals. Any outbreak would require the hospital or units of the hospital to go on diversion. Who in a community would electively decide to receive care from a facility that has had an outbreak of any significance that is reported by the news?
These are complex issues and currently we need leadership from the academic facilities to develop best practices to prevent future lawsuits from patients who develop a nosocomial (hospital acquired) infection. Further, the government must mandate application of best practice as a condition for payment. Adequate funding by government payment sources must support any mandate.
Read Parts 1-4 regarding Decubitus Ulcers on the serious injury lawyer news blog.
Source: Sacramento Injury Lawyer Dr. Greg Vigna
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