Remind your daughters: Mariana Bridi da Costa's misdiagnosed fatal infection

The 20-year-old Brazilian beauty queen Mariana Bridi da Costa died early this morning in the hospital. She had had a urinary tract infection (UTI), which was initially misdiagnosed, delaying the routine antibiotic treatment that probably would have saved her life.

The bacterial infection progressed rapidly, snowballing into more serious conditions. First, it spread to her blood ("septicemia"). The septicemia then caused an insufficient blood flow that triggered the quick deadening of tissue ("necrosis"), first in Mariana's hands and feet. But even the prompt amputation of her hands and feet could not save her life, as the septicemia (also called bacteremia or sepsis) apparently led to organ failure and her death.

As of now, it's not known whether she had acquired the UTI at home or in the hospital. Her boyfriend said she had felt ill in late December, perhaps from a UTI, and that her doctor had misdiagnosed the problem as a kidney stone, and prescribed medicine for that. This incorrect diagnosis evoked a wrong-drug error. The type of bacterial infection she had - Pseudomonas aeruginosa - is usually acquired in the hospital, not at home. A hospital-acquired infection, whose detection was delayed, may well have led to her death.

Mariana had been a finalist to represent Brazil in the Miss World contest.

Advice to mothers: Remind your daughters that they can prevent some UTIs by wiping themselves from front to back after using the toilet. Doctors can prevent some hospital-acquired UTIs by washing their hands before touching patients.

Read another Pseudomonas aeruginos story.

Thanks to Shari Roan for the source article in yesterday's Los Angeles Times.

I’m sure they have some record: A laboratory medical error

The last time she saw her father - a soft-spoken man who "always had a joke for everyone" - was when she visited her parents' home in Florida for Christmas. "He was great," Jeanne Zeller said. "He even carried my luggage for me."

Around a week later, though, Thomas Zeller started to have shoulder pain. After enduring it for a week, the 69-year old man checked into the hospital, on Jan. 8, 2006. His initial vital signs were normal and his chief complaints were left shoulder pain and right hand swelling. X-rays of Zeller's left shoulder showed a slight dislocation of bone. On his first day in the hospital, he was given a Foley catheter to help with urine retention.

Thomas' temperature spiked to 102 degrees during the late evening of Jan. 11, and a blood culture was taken the next day. Meanwhile a cardiac catheterization on Jan. 11 had suggested dysfunction of the heart muscle (cardiomyopathy). Though the condition was serious, it didn't warrant his staying in the hospital any longer, and he was discharged to a nursing home on Jan. 14.

Thomas’ fever continued to spike during the next week, while he was having rehabilitative physical therapy in the nursing home. At the end of that week, he was transferred back to the hospital, on Jan. 20. There, the blood and urine cultures revealed Pseudomonas aeruginosa, a "superbug" resistant to most antibiotics. From there, his condition deteriorated, as the infection spread to his heart valves. On Feb. 15, Zeller's wife signed the "do not resuscitate" order, and he died soon afterward.

The superbug had spread, unknown and untreated, for a week, because the Jan. 12 blood culture result was delayed or missing until after he left the hospital. "By not having important lab results in the chart in a timely manner," Jeanne Zeller wrote to the Florida Agency for Health Care Administration, the hospital "sentenced my father to death."

The most likely explanation: "Persistent Pseudomonas aeruginosa bacteremia blood poisoning probably started off as a urinary tract infection," Dr. Murali Puthisigamani wrote after examining Thomas on Jan. 30.

The hospital had made at least three errors. First, unsanitary conditions were surprisingly prevalent. Three of nine patients sampled by AHCA "were not provided catheter care and/or personal hygiene care," according to AHCA’s report. Second, the initial lab result was delayed. Third, when the critical result was determined, staff told no one. Apparently the hospital had no effective system in place to immediately sound an alarm to doctors when laboratory staff learn of such critical lab results (also called "panic values").

The AHCA inspector had asked the infection control nurse why Thomas Zeller's Jan. 12 blood culture never made it to his chart. Her response: "If a patient left before the final results were in, they may be - I don't know how medical records does their filing. I'm sure they have some record."

Advice: Before you let your father into a hospital, ensure that the hospital participates in the Five Million Lives campaign of the Institute for Healthcare Improvement.

Read a story on misplaced lab results, or read Elena Lesley’s source story, dated April 1, 2007.