Study: Kids’ MRSA blood infections less deadly but still a problem

first_imgA study today in Pediatrics indicates that MRSA bloodstream infections affect children differently than adults, and that without early and aggressive treatment, children are at risk of developing serious complications.In a retrospective study of more than 200 children diagnosed as having methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, researchers found that while mortality was low and the median duration of MRSA bacteremia is much shorter in children than in adults, nearly a third experienced treatment failure. And with each additional day the blood infections linger in children, the increased risk of developing complications rose by 50%.”It really highlights differences in what we know about epidemiology of infections in children compared to in adults,” study author Rana Hamdy, MD, MPH, director of the antimicrobial stewardship program at Children’s National Health System, said in an interview.The findings also suggests further research is needed to pinpoint the proper amount of vancomycin—the antibiotic of choice for MRSA infections—needed in children with MRSA bacteremiaTreatment failure commonOf the 278 children with MRSA bacteremia identified by the researchers in three children’s hospitals in Pennsylvania, Maryland, and Utah, 232 met the criteria for inclusion in the study. The median age of the children was 5.3 years. The primary sources of the infection in the children were osteomyelitis, or bone infections (31%), catheter-related bloodstream infections (22%), and skin and soft-tissue infections (16%).Bone infections tend to be common in children because their growing bones require a greater blood supply.While MRSA bloodstream infections in adults are generally healthcare-associated, 78% of the children’s were community-onset, meaning they occurred in the home or in another non-healthcare setting, such as a school or daycare center.Of the 232 children with MRSA bacteremia, 31% experienced treatment failure, which was defined as 30-day MRSA-attributable mortality, recurrence of bacteremia within 30 days, and persistence of bacteremia for more than 3 days. Twenty-three percent of the children developed complications, including blood clots and the spread of the initial infection to another site in the body.Five of the patients (2%) died within 30 days. The median duration of bacteremia was 2 days.In adults, by comparison, mortality from MRSA bacteremia can be as high as 30%, and the pathogen remains in the bloodstream for an average of 8 to 9 days.To determine the criteria for treatment failure, Hamdy and her colleagues did a secondary analysis of the outcomes. From that analysis they determined that endovascular infections (odds ratio [OR], 4.45), musculoskeletal infections (OR, 2.4), and critical illness (OR, 2.77) were all associated with increased odds of treatment failure.Hamdy explained that the duration of bacteremia will generally be longer when there is a greater burden of bacteria in the blood, and that occurs when the main sources of infection are large bones or the heart. “It seemed that those were the infections that were harder to clear, and those children ended up having the bacteria detected in their blood for longer periods,” she said.Also, further analysis showed that for those children who had bacteremia for longer periods, every 1-day increase in duration was associated with a 50% increase in the odds of developing complications.Early, aggressive treatmentFor Hamdy, this in an indication that clinicians need to administer appropriate antibiotic therapy and make sure they drain any abscesses—which frequently occur in MRSA infections—early on in the infection. “For patients who have MRSA bloodstream infections, early and aggressive therapy with both antibiotics and appropriate source control, with drainage of any abscesses, is going to be very important to reduce the risk of complications,” Hamdy said.But Hamdy and her colleagues found that appropriate antibiotic therapy for children with MRSA bacteremia may also look different than it does for adults. Unlike in adults, who are more likely to experience treatment failure when they have low concentrations of vancomycin in the blood, treatment failure in children was not linked to vancomycin concentrations.This finding could be important, the study notes, because the high doses of vancomycin recommended for adults with invasive MRSA infections have been linked to nephrotoxicity (toxic damage of the kidneys) in children. “Additional studies are needed to better understand what the target dose or concentration should be in children,” Hamdy said.Beyond the implications for treatment of MRSA bacteremia in children, Hamdy thinks the study shows that bacterial infections in children may need to be managed differently than they are in adults. “A lot of our management practices, even when it comes to doses of antibiotics in children, have been extrapolated from adults,” Hamdy said. “I think this is one of many examples that show we really can’t do that, because the epidemiology, the outcomes, the characteristics of these infections are very different in children than they are in adults.””We need to understand how these infections affect children distinct from how they affect adults, and I don’t think we can make any assumptions about the way that diseases play out in children based on what they do in adults,” she added.See also:May 5 Pediatrics studylast_img read more

Insolvency

first_img Jane Lambert (instructed by Public Access Rules) for the appellant; Stephen Davies QC (instructed by Eversheds) for the respondent. Practice statements – Proportionality – Remuneration – Trustees in bankruptcy The appellant bankrupt (B) appealed against a decision fixing the remuneration of the trustee in bankruptcy (R). B ran a small retail flower business. She did not keep up with her VAT payments and was made bankrupt on a petition by HM Revenue & Customs. R was appointed as trustee. It was agreed that B’s husband would purchase the business and assets for £10,000. In addition to the flower shop business, the other substantial asset in B’s estate was a half-share in the matrimonial home valued at about £165,000. B made an application for annulment of her bankruptcy. The claim of the Revenue was settled at £15,177. B’s bank was a creditor for a total of £10,347 on two unsecured accounts, a current account and a loan account. The annulment application was adjourned more than once. There were issues as to whether and, if so, how debts had been paid, and B was challenging the amount of the bankruptcy costs and disbursements. A meeting of creditors, attended by the Revenue by proxy, had resolved that R’s remuneration should be fixed by reference to the time properly given by him and his staff in attending to matters arising in the bankruptcy. At first instance, the district judge fixed R’s costs and remuneration at £20,354, with additional disbursements of £2,890, and assessed his solicitors’ costs at £23,086, together with a small amount for disbursements. On appeal the judge, sitting with two assessors, fixed R’s costs and remuneration, excluding disbursements, at £9,929 and assessed the solicitors’ costs at £10,038. R’s disbursements and most of the solicitors’ disbursements were also allowed. B argued that even the reduced figure for R’s remuneration was disproportionately high in relation to the circumstances of the bankruptcy, did not have regard to the Practice Statement (Ch D: Fixing and Approval of Remuneration of Appointees) [2004] BCC 912 Ch D, and in particular to the principle that the remuneration of the trustee in bankruptcy should reflect and be fixed so as to reward the value of the service rendered by him, not simply to reimburse him in respect of time expended and cost incurred, and did not properly take into account the status of the trustee in bankruptcy as a fiduciary. Held: (1) The Practice Statement of itself could not make law on substantive issues or require courts to apply the guiding principles stated in it. But the Practice Statement was not an attempt to create a new set of principles, but a convenient means of gathering together in one place the principles to be derived from the Insolvency Rules and authority, Mirror Group Newspapers Plc v Maxwell (No1) [1998] BCC 324 Ch D considered. The Practice Statement acquired authority as a statement of guiding principles if it was expressly approved and applied as such in judgments at an appropriate level, and it had been. Although the guiding principles were expressed to apply to applications for fixing and approving remuneration, it was clear that they would be applied also to a challenge, taking into account that the remuneration or its basis had been duly fixed under the Insolvency Rules by a relevant body, such as a creditors’ committee or meeting of creditors. A court hearing an application to fix or to challenge the remuneration of an office-holder should proceed on the basis that the Practice Statement was to be applied, except in so far as in the circumstances of the particular case the party objecting to its application showed that it would be wrong in principle to do so (see paragraphs 42-48 of judgment). (2) The principles set out in the Practice Statement should have been expressly applied, but that omission was not a ground for allowing the appeal. The judge applied what were fundamentally the relevant criteria. He examined in some detail, with the benefit of the assessors, the remuneration claimed and the work done, in terms of value more than time, bearing always in mind the need to arrive at a figure which was proportionate to the circumstances of the bankruptcy. It was not open to the judge wholly to disregard the time spent by R, both because it was a relevant, but not decisive, factor in any case and because the basis of his remuneration had been fixed at the meeting of creditors. In relation to the issue of proportionality, the number and size of claims and the number and value of assets was an important, but not the only, element in the circumstances of the bankruptcy. There were many ways in which costs could properly be incurred which were not related, principally or even at all, to the assets and liabilities of the estate. In the instant case, B’s conduct in relation to the application to annul plainly did increase R’s costs. As to the issue of hourly rates, B adduced no evidence as to local charging rates and the judge and the assessors must have had some knowledge of those rates. B had had the benefit of a detailed examination of R’s remuneration, resulting in a very substantial reduction. Applying expressly the principles in the Practice Statement, the result would not be materially different (paragraphs 86-90). Appeal dismissed. center_img Helen Brook v Nicholas Edward Reed (trustee in bankruptcy of the estate of Helen Brook): CA (Civ Div) (Lady Justice Arden, Lord Justice Black, Mr Justice David Richards): 25 March 2011last_img read more

Tanker truck catches fire past Chetwynd

first_imgCHETWYND, B.C. – A truck hauling 40 000 liters of crude oil has had a fire about 20 km west from Chetwynd on Highway 97 at about 10 a.m. Sunday. The fire has been isolated to the rear tires of the unit and no product has been lost. The company has dispatched another unit to continue to take the product from the highway. – Advertisement -This crude oil is being transported to a Prince George refinery. RCMP are on site and Drive BC will be updated as the road is open in both directions. The incident has been downgraded from a Code 2 to a Code 1 as it is under control.(PEACE FM)Advertisementlast_img read more