In March, 14-year-old Miles Freeman and 4-year-old Jasie Musick were in side-by-side intensive care unit rooms being treated for viral pneumonia with a bacterial lung infection stacked on top, a “bacterial superinfection.”
The Freeman family offered advice to the Musick family about ECMO (Extracorporeal Membranous Oxygenation), the top level of life-support technology, when Jasie was also placed on ECMO. The families became close, but on March 10, Miles died. A little more than a month later, Jasie would leave the hospital, on her way to a full recovery.
Why one young patient dies while another, with a seemingly similar disease, lives is the sort of question that keeps intensivists like Geoffrey Fleming, M.D., assistant professor of Pediatric Critical Care, up at night.
“The day after Miles died I was on the phone with my ECMO mentor in Michigan. I called her because it was frustrating. Miles was in the bed next to Jasie in the Pediatric ICU, but he was dying, and Jasie was going to get better,” said Fleming.
One obvious difference was that the bacteria causing Jasie’s superinfection was a type of Staphylococcus that still responds to older therapies, called MSSA (methicillin-sensitive Staphylococcus Aureus). Miles was infected with the increasingly common resistant, and harder to treat, strain of staph, called MRSA (methicillin-resistant Staphylococcus Aureus).
“MRSA was the obvious difference, but we had other patients who have had bad MRSA and got better,” Fleming says. “So why couldn’t we get Miles better?”
Now Vanderbilt physicians and others around the country hope to convene a small group study to look carefully at cases of influenza with superinfection. They will connect through the nationwide Extracorporeal Life Support Organization (ELSO) to discuss how this study might be developed.
“We want to see if there are variables we can identify early on in these illnesses. The hope is when we get the Miles Freemans and Jasie Musicks, can we find a way to change those modifiers. Maybe it will make the difference between death and survival,” said Fleming.
– by Carole Bartoo