59 y/o female admitted to Hospital in Florida on 11/11/18 with severe burns when she inadvertently ignited herself with a cigarette while at a rehab center.
During 66 day hospitalization developed MRSA. CT chest abdomen and pelvis on 12/7/18 and 1/8/19 were negative for any occult source of infection. Treated and discharged with negative cultures on 1/16/19. While at a rehab facility in March, Patient began c/o back pain for 2 weeks prior to being transported to a different Hospital on 4/2/19 where a BC was positive for MRSA.
MRI diagnostic for an epidural abscess. Surgery was performed and spinal culture was positive for MRSA.
Patient discharged on 4/11/2019 with negative cultures.
I am not questioning the treatment of the MRSA and therefore am not looking for an expert to opine on the standard of care or whether a Dr. was negligent. I am looking for an expert in infectious disease to opine on the origin of the MRSA abscess. More specifically, is the abscess, more likely than not, the result of the burn injuries and subsequent rehab stays. In other words, but for the burn injuries, would the patient have developed an epidural abscess.
Files:
Q: Burn may or may not be associated with de epidural abscess. It is a chance, but still patient may have had other port of entry for the bacteremia like central vein catheters. It is just impossible to know.
A: —
Do you believe there might have been medical error?
It is likely and plausible that the initial MRSA during the first hospital stay seeded the back to cause the second identified infection. The duration and type of antibiotics need to be identified and delineated. But evidently the infection of the burn wounds spread to back. Not certain but likely. It is important to see if the two MRSA isolates are similar or identical either in terms of antibiogram or other ways. My opinion would likely be that in the absence of burns there would not have been a spinal abscess.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
See above. I think that this patient had bad luck and unlikely was victim of medical error. Unless the antibiotic duration was not enough or back pain was ignored I don’t (yet) evidence of medical error.
What makes you a good expert for this case?
I have seen hundreds of similar cases. I have been an extraordinarily effective expert in supporting the side that picks me; following the facts my position as a Yale professor evidently is very convincing to the other side. I have credibility because I make opinion based on the facts.
How often do you encounter cases similar to this one in your practice?
Several times monthly. This syndrome is common in my practice.
Do you believe there might have been medical error?
On day 66 of hospitalization developed a MRSA infection, how was treated and whether current treatment guidelines were applied? If MRSA infection was not properly treated, then this can justify why she developed the epidural abscess which may have been prevented.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If the MRSA infection was initially not treated per standard of care, then there may be a malpractice case
What makes you a good expert for this case?
Has seen hundred of MRSA infections with epidural abscess, being a associate professor of medicine keeps me with most recent updated guidelines of MRSA infection
How often do you encounter cases similar to this one in your practice?
Every week I have seen a case like this for the last decade. When no treated properly, MRSA may cause these complications.
Do you believe there might have been medical error?
I think the MRSA infection of the spine is most commonly due to bacteremia. Bacteremia could be from an infected central line or bacteremia from a skin infection.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Did the patient have any signs of skin infection while hospitalized? How soon was this addressed? Did the treating physicians document the patient's skin condition regularly?
What makes you a good expert for this case?
I have over 20 years experience as a board-certified infectious disease physician.
How often do you encounter cases similar to this one in your practice?
I regularly consult on the management of bacteremia, infections of the skin, soft tissues, and bones, I manage an antibiotic stewardship program for my hospital.
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