DNA-Based Forensics Sheds Light On Infections From Heater-Cooler Units
Last October, this column discussed infections linked to the use of these devices, which regulate body temperature during certain heart and lung operations, via circulation of water in tubes. Of special interest is Mycobacterium chimaera, an organism typically found in soil and tap water. Unfortunately, the heater-coolers can aerosolize the bug and spray it directly into the chest cavity during surgery. Making matters worse, M. chimaera is slow growing, and symptoms can take months or even years to manifest.
A study published July 12 in The Lancet Infectious Diseases claims to have discovered the source of the bacteria. Researchers compared samples from 32 infected patients to isolates taken from two brands of heater-coolers (LivaNova and Maquet), and found a high degree of similarity in bacterial DNA between patient samples and those from LivaNova heater-cooler units and the LivaNova factory.
“Our study closes the missing gap,” said Stefan Niemann, a professor with the German Center for Infection Research and one of the study’s co-authors. Response from LivaNova indicated that “[T]he article expresses a level of certainty about a point source tie to the manufacturing process that is not warranted by the data.”
Assigning blame is one thing, but prevention is quite another. At the University of Iowa Hospitals and Clinics, where six patients developed infections tied to heater-cooler units, experts solved the problem by putting the devices in a room connected to—but separate from—the operating room, said Dr. Michael Edmond, clinical professor of infectious diseases. The policy was instituted in January, 2016, and no new infections have occurred.
Big-Time Med School Dean Has A Serious Drug Problem
This one has been well-covered by the LA Times. Writer Steve Lopez and his colleagues detail the misdeeds of former USC School of Medicine dean Dr. Carmen Puliafito—including drug-fueled parties with a prostitute, convicted criminals, and drug addicts. But, for Lopez, as well as me, the larger issue is the non-action and cover-up of Puliafito’s problems, since he had a great talent for bringing in major donations.
He resigned as dean in March, 2016, in the wake of an incident at a Pasadena hotel in which a much younger woman overdosed in his room, although no one knew about this at the time. The stated reason was that he wished to “move on and pursue a job in biotech.” Strangely, no police report was filed, and even though USC knew that Puliafito had a serious drug problem, they allowed him to keep seeing patients until the story broke on July 17, 2017. So far, USC President Nikias has kept mum.
Even as a UCLA alumnus (our mortal enemy was USC), it gives me no pleasure to relate this quote from a faculty member: “What an embarrassing time to work for USC and Keck School of Medicine. To me, it seems like the university needs a complete moral inventory/overhaul.”
Some Good Advice From An ER Doc
Edwin Leap, MD has a column on KevinMD. Here are some thoughts from his recent entry entitled “Cheaper health care isn’t hard.”
“I think a lot about what brings people to the hospital. And I have come to some conclusions. If people want to live healthier, longer and better, then the solutions are not especially complex. But they involve pretty hard decisions. They don’t, however, involve pills.” Yes, he makes exceptions for people with legit serious conditions. He’s talking lifestyle changes.
Don’t smoke. Eat less. “Stop sitting around. Do things. Be busy. Walk, hike, have an active hobby. Stop binge watching shows for hours (in fact, a study not long ago suggested that binge watching increases your risk of dangerous blood clots in the lung).”
“Some of my favorite patients are the 90 year olds who show up for something simple—a bruise or a cut, fresh from yard work.” They aren’t on any meds, and in the particular case he relates, do not even have a regular doctor.
Leap tells the patient: “Well there you go. That’s why you’re 90.”
Michael D. Shaw