Thursday, November 10, 2005

Antibiotic-free hospitals

NEW YORK (Reuters Health) - The growing problem of drug-resistant staph infections in hospitals needs a fresh approach -- including antibiotic-free hospitals and perhaps a dose of "good" bacteria on surgeons' hands, one researcher argues.

Writing in the Annals of the Royal College of Surgeons of England, Dr. Mark Spigelman lays out a proposal for combating methicillin-resistant Staphylococcus aureus, or MRSA. This so-called "superbug" is untreatable with most antibiotics and can cause potentially deadly complications like pneumonia, bloodstream infections and surgical wound infections.

Though MRSA outbreaks have been turning up in the general population in recent years, hospitals and nursing homes remain the bug's prime breeding ground, with patients with weakened immune systems being most vulnerable.

Given this, it's time to take another look at why MRSA thrives in such antiseptic places, according to Spigelman, of the University College London.

The question to be asked, he told Reuters Health, is why MRSA infections are widespread only in hospitals.

The answer, according to Spigelman, may be found in the very practices that hospitals use to combat bacterial infection: hand scrubbing and antibiotics.

It's known that overuse and improper use of antibiotics are the main reasons that staph and other bacteria have developed resistance to the many of the drugs; when disease-causing bacteria are exposed to, but not killed by, antibiotics, they can mutate in ways that render the drugs ineffective. And while other bacteria, good and bad, are killed off by antibiotics, resistant strains are free to thrive.

Designating certain surgical hospitals as "antibiotic-free" would cut patients' risk of developing MRSA after an operation, Spigelman argues. Patients who do develop a wound infection would have to be transferred to a hospital where antibiotics are used.

In addition, surgeons and staff working in antibiotic-free centers could not enter antibiotic-using hospitals, in order to prevent them from picking up MRSA.

The other part of Spigelman's proposal focuses on how surgeons' hands, and even patients' wounds, are cleaned. Similar to what happens with antibiotics, washing away the many harmless or "good" bacteria on the skin may "allow room" for MRSA and other resistant bugs to settle, Spigelman points out.

That doesn't mean it's time to scrap hand-washing, he said. Instead, he argues, studies could look into the usefulness of solutions containing beneficial bacteria, called probiotics. These bugs include the bacteria used in fermented foods like yogurt.
Bacteria, Spigelman points out, generally don't lie down on top of each other, but settle in isolated colonies. So slathering a probiotic solution on clean skin could set up a healthy population of good bacteria that would crowd out any harmful bugs that would have taken residence.

Whether surgeons will start dipping their hands in yogurt remains to be seen. But, Spigelman notes in his article, dental researchers are already looking into whether probiotics can save people's teeth by displacing the bacteria that cause cavities.

SOURCE: Annals of the Royal College of Surgeons of England, November 2005.
By Amy Norton, © Reuters 2005. All Rights Reserved