WEDNESDAY, June 12, 2002 (HealthDayNews) -- The latest entry in a long debate about using antibiotics to prevent hospital infections gives a qualified OK to the practice.
The debate isn't about the danger of in-hospital infections, which cause thousands of deaths every year. The concern is that overuse of antibiotics can end up making the problem worse by creating impossible-to-treat superstrains of bacteria that are antibiotic-resistant.
The latest study, however, says a brief course of one specific antibiotic can reduce hospital infections significantly without necessarily breeding resistant bacteria.
The study centered on Staphylococcus aureus, a common cause of hospital infections and one that is carried by a large percentage of all Americans.
"About 25 percent of us are colonized," says Dr. Trish M. Perl, associate professor of medicine at Johns Hopkins Medical Institutions and lead author of a report on the study in tomorrow's issue of the New England Journal of Medicine.
The staph bacteria normally are found in the nose and cause no problem in everyday life. But they can cause a problem when they invade a surgical incision.
In the study, doctors at two Iowa medical centers tested more than 4,000 patients who underwent a variety of surgical procedures to see whether they carried staph. More than 800 of the people who did were divided into two groups. One group was given a five-day course of an ointment containing mupirocin, an antibiotic marketed as Bactroban by GlaxoSmithKline, which paid for the study. The ointment was swabbed in the nose. The other patients got an inactive ointment.
The rate of infections at the site of surgery was identical in both groups. But the overall incidence of infections was significantly lower for those who got the antibiotic ointment -- 4 percent, compared to 7.7 percent for those who got the inactive ointment.
Does this mean that every surgery patient should be tested for nose staph and should get mupirocin if the test is positive?
Not really, Perl says.
To start with, most hospitals can't do the tests, she says.
"At this point in time, no test is commercially available," she adds. "Most institutions do not have access to technologies that rapidly identify patients who are colonized. Only large research institutes have them."
It's better to target the treatment to patients at highest risk of hospital staph infections, Perl says. These can include people with diabetes, those infected with HIV, the virus that causes AIDS, and people with skin diseases. And certain operations seem to make people more vulnerable to staph infections -- heart surgery and spinal fusions, among others.
And mupirocin ointment should be used with care, Perl adds.
"The drug has absolutely no side effects, so the concern is that it can be used too widely and abused," she says. "If you look in the literature, you can see that resistance occurs in places where they use the drug over large areas, like wounds or ulcers. It should be used only in the nose and for a short period of time."
Resistant strains were found in only four of the patients in the study, Perl notes.
An accompanying editorial in the journal, by Dr. Barry M. Farr of the University of Virginia Health System, says the new study adds to the evidence that antibiotics, properly used, can prevent hospital staph infections.
But Farr wrote: "Important questions remain concerning the cost effectiveness of this approach, whether other species cause more infections as the rate of S. aureus infections declines, and which regimens and strategies are optimal."
"Ideally," Perl says, "we would like to see another study done to verify these findings."
What To Do
You can learn more about the problem of antibiotic resistance from the Alliance for the Prudent Use of Antibiotics or the Centers for Disease Control and Prevention.
