Mismanaged Case of MRSA Results in Fatality

This case involves a fifty-nine year old man with a history of COPD who was admitted to the hospital for an episode of shortness of breath and chest pain. The patient’s respiratory exacerbation was stabilized over a seven-day hospital stay, but the day before his discharge, the patient had a positive nasal culture for MRSA. The hospital staff neglected to change his medication to reflect his new status as a carrier for the resistant bacterial strain. After physicians performed a bronchoalveolar lavage, the patient began to decompensate over the following days that was also positive for MRSA. The patient became septic, went into shock, and died shortly thereafter.

Question(s) For Expert Witness

1. What are the current guidelines to prevent the spread of MRSA in hospitals?

Expert Witness Response E-004618

A large study in adult inpatients has demonstrated that universal surveillance, appropriate use of contact precautions and hand hygiene, and institutional culture change can decrease infections with MRSA. Another approach likely to be cost-saving and to decrease infection in the intensive care unit is targeted screening and nasal decolonization, although the benefits of nasal decolonization outside this setting remain undefined. It is important to appropriately monitor renal function, CBC count, and serum hepatic transaminase levels while patients with Staphylococcus aureus infection are undergoing therapy. This ensures eradication and prevents drug-resistant strains of the disease.