Studies: gator blood, sudden infant death syndrome

I blogged earlier on new research that alligator blood may contain potent antimicrobial compounds. Now the Miami Herald has done a nice long story that thoughtfully explores the possibilities and limitations of that research. (Hat tip to KSJ ScienceTracker for noting the story.)

And via the BBC, here is a report that British researchers believe some vases of Sudden Infant Death Syndrome (which the English call " sudden unexpected death in infancy (SUDI)") may be due to undetected bacterial infections.

The researchers took samples from 470 babies who had died suddenly, and tested them for the presence of bacteria, particularly those capable of causing illness, such as Staphylococcus aureus or E. coli.
In some cases, the cause of death was known to be a bacterial infection, or completely unrelated to infection, for example a heart defect or accident. The rest were entirely unexplained.
Among those known to have died from a bacterial infection, 24% of the bacteria found were potentially harmful, compared with only 11% of those found in the non-infection group.
However, among the "unexplained" group, the figure was 19%, with 16% of bacteria found in this group identified as Staphylococcus, compared with 9% in the non-infection group. (Emphasis added.)

The authors theorize that toxins produced by staph could interfere with breathing or affect the nervous system. The paper, just published by The Lancet, is here and a Lancet-produced podcast (.mp3) is here.

Hospital gives patient MRSA. Should Medicare reimburse?

You have until June 13th to tell the government what you think. Details of how to comment at the end of this post because they are complicated.

Here's the back-story: Until recently, hospitals were reimbursed by the Center for Medicare and Medicaid Services (part of the US Department of Health and Human Services) whenever they provided care to Medicare or Medicaid patients, even if that care included a mistake, error or hospital-acquired infection. Thankfully, that is beginning to change. Last December, CMS proposed a rule change. In the agency's language:

Beginning October 1, 2008, Medicare will no longer pay hospitals at a higher rate for the increased costs of care that result when a patient is harmed by one of several conditions they didn’t have when they were first admitted to the hospital and that have been determined to be reasonably preventable by following generally accepted guidelines. (Quoted from this press release.)

In other words: Hospitals, you break it, you bought it.

These are the conditions for which, as of Oct. 1, 2008 (the first day of federal fiscal year 2009), Medicare will not reimburse:

• Object inadvertently left in after surgery
• Air embolism
• Blood incompatibility
• Catheter associated urinary tract infection
• Pressure ulcer (decubitus ulcer)
• Vascular catheter associated infection
• Surgical site infection - Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
• Certain types of falls and trauma.

Note: MRSA is not on that list. But: At the same time, CMS proposed a second set of error-related conditions for which it will consider not-reimbursing, based on public comment. Some of those conditions are MRSA-related. The conditions are:

• Surgical site infections following certain elective procedures.
• Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
• Extreme blood sugar derangement
• Iatrogenic pneumothorax (collapse of the lung)
• Delirium
• Ventilator-associated pneumonia
• Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
• Staphylococcus aureus septicemia (bloodstream infection)
• Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

CMS will decide whether or not to include any or all of those additional events by Aug. 1. The non-reimbursement would start at a later date that the first list.

This a complex topic and there is a long paper trail attached to it. Fact sheets are here. Definitions of the conditions, as accepted by CMS and the CDC, are here. The records of the Dec. 17. 2007 hearing in which this was discussed, including complete transcripts, is here.

Directions for how to comment electronically and by mail and hand-delivery (faxes are not accepted) are contained in this long Federal Register entry. Here is how to do it electronically:

• Go to http://www.regulations.gov
• Under "Comment or Submission," enter this file-code: CMS–1390–P
• Click on "Send a comment or submission" in the left-middle of the page.
• Fill out the form that comes up (you may have to page-down to see the full form).

Rumors of the blog's death are only slightly exaggerated (3d ed.)

Apologies for the non-appearance: I am deep into writing (and also continuing research travel) and it's hard to carve out the extra hour a day. But here is something new that is worth posting on. Jeanine Thomas, MRSA patient and prominent activist, has put up a site, blog and online community for MRSA stories and activism. Thomas, who lives in Chicago, contracted and almost died from a MRSA infection following ankle surgery in 2000 and went on to lead one of the first successful efforts to enact state legislation for MRSA control.

Find the MRSA Survivors Network in the blogroll and here.