Careful cleaning of children’s skin wounds key to healing, regardless of antibiotic choice

Careful cleaning of children’s skin wounds key to healing, regardless of antibiotic choice
Hopkins Children’s study suggests antibiotics may not always be best therapy

From the February 21 Eureka news alert

When it comes to curing skin infected with the antibiotic-resistant bacterium MRSA (methicillin-resistant Staphylococcus aureus), timely and proper wound cleaning and draining may be more important than the choice of antibiotic, according to a new Johns Hopkins Children’s Center study. The work is published in the March issue of Pediatrics.

Researchers originally set out to compare the efficacy of two antibiotics commonly used to treat staph skin infections, randomly giving 191 children either cephalexin, a classic anti-staph antibiotic known to work against the most common strains of the bacterium but not MRSA, or clindamycin, known to work better against the resistant strains. Much to the researchers’ surprise, they said, drug choice didn’t matter: 95 percent of the children in the study recovered completely within a week, regardless of which antibiotic they got.

The finding led the research team to conclude that proper wound care, not antibiotics, may have been the key to healing.

“The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week,” says study lead investigator Aaron Chen, M.D., an emergency physician at Hopkins Children’s. “The better news might be that good low-tech wound care, cleaning, draining and keeping the infected area clean, is what truly makes the difference between rapid healing and persistent infection.”

Chen says that proper wound care has always been the cornerstone of skin infection treatment but, the researchers say, in recent years more physicians have started prescribing antibiotics preemptively.

Although the Johns Hopkins investigators stop short of advocating against prescribing antibiotics for uncomplicated MRSA skin infections, they call for studies that directly measure the benefit — if any — of drug therapy versus proper wound care. The best study, they say, would compare patients receiving placebo with those on antibiotics, along with proper wound cleaning, draining and dressing.

Antibiotics can have serious side effects, fuel drug resistance and raise the cost of care significantly, the researchers say.

“Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case,” says senior investigator George Siberry, M.D., M.P.H., a Hopkins Children’s pediatrician and medical officer at the Eunice Kennedy Shriver Institute of Child Health & Human Development. “We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them.”

The 191 children in the study, ages 6 months to 18 years, were treated for skin infections at Hopkins Children’s from 2006 to 2009. Of these, 133 were infected with community-acquired MRSA, and the remainder had simple staph infections with non-resistant strains of the bacterium. Community-acquired (CA-MRSA) is a virulent subset of the bacterium that’s not susceptible to most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in those who are sick or have weakened immune systems, it can lead to invasive, sometimes fatal, infections.

At 48-hour to 72-hour follow-ups, children treated with both antibiotics showed similar rates of improvement — 94 percent in the cephalexin group improved and 97 percent in the clindamycin group improved. By one week, the infections were gone in 97 percent of patients receiving cephalexin and in 94 percent of those on clindamycin. Those younger than 1 year of age and those whose infections were accompanied by fever were more prone to complications and more likely to be hospitalized.

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Co-authors on the study included Karen Carroll, M.D., Marie Diener-West, Ph.D., Tracy Ross, M.S., Joyce Ordun, M.S., C.R.N.P., Mitchell Goldstein, M.D., Gaurav Kulkarni, M.D., and J.B. Cantey, M.D., all of Hopkins.

The research was funded by a grant from the Thrasher Research Foundation and the General Clinical Research Center at Johns Hopkins.

Related:

Knowledge Gaps, Fears Common Among Parents of Children with Drug-Resistant Bacteria http://www.hopkinschildrens.org/Fears-Common-Among-Parents-of-Children-with-Drug-Resistant-Bacteria.aspx

Community-Acquired MRSA Becoming More Common in Pediatric ICU Patients http://www.hopkinschildrens.org/Community-Acquired-MRSA-Becoming-More-Common-in-Pediatric-ICU-Patients.aspx

 

 

 

 

Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units

Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units

From the January 31, 2011 AHRQ (Agency for Healthcare Research and Quality) press release

Older Americans who were treated in Michigan intensive care units (ICUs) saw larger decreases in their likelihood of dying while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new study evaluating an innovative quality improvement initiative funded by HHS’ Agency for Healthcare Research and Quality (AHRQ). The initiative, known as the Keystone Project, targeted ways to reduce the number of healthcare-associated infections (HAIs). Previous research has shown that targeted quality improvement programs can reduce HAI rates. This study, “Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis,” published in today’s British Medical Journal, is the first to link these programs to reduced death rates. “This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save lives—the most important outcome for patients and doctors,” said AHRQ Director Carolyn M. Clancy, M.D. “AHRQ and others have already initiated work to expand this project nationwide to other ICUs across the country.” Researchers led by Allison Lipitz-Snyderman, Ph.D., of The Johns Hopkins Bloomberg School of Public Health, analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern states. They looked at data before the project was initiated, while it was being phased in, and up to 22 months after implementation. The researchers found that overall a person’s chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern states where the program was not implemented. “We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives,” says Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine. Dr. Pronovost led development of the AHRQ-sponsored Keystone Intensive Care Unit Project and implemented it in Michigan hospitals with the help of the Michigan Health and Hospital Association. “These results are very exciting, and further research should be done to address other important issues impacting the safety and quality of patient care,” added Dr. Lipitz-Snyderman. The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety, improving communication among ICU staff teams, and implementing practices based on guidelines by the Centers for Disease Control and Prevention (CDC), such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. AHRQ continues to support the Keystone Project through a contract with the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. For AHRQ’s recently funded HAI projects, go to http://www.ahrq.gov/qual/haify10.htm. According to the CDC, HAIs are one of the most common complications of hospital care, accounting for an estimated 1.7 million infections, and 99,000 associated deaths in 2002. These infections are responsible for $28 billion to $34 billion in preventable health care expenses every year. Infectious agents, such as bacteria, found in health care settings can cause patients to develop HAIs when they have surgery or require central lines or urinary tract catheters. The Keystone Project is part of a Department-wide effort to address HAIs, as outlined in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ash/initiatives/hai/index.html). Partners across HHS, including AHRQ, CDC, the Centers for Medicare & Medicaid Services, and National Institutes of Health, are working together to achieve the goals of the Action Plan. For more information, please contact AHRQ Public Affairs: (301) 427-1864 or (301) 427-1855. Use Twitter to get AHRQ news updates:http://www.twitter.com/ahrqnews/

Additional articles about this news release

• Safety checklist use yields 10 percent drop in hospital deaths (Science Blog)
• Program reduces serious hospital infections – report (Reuters)

Articles about related studies

• Study finds MRSA screening saves hospitals money
• Private room intensive care unites associated with lower infection rates
• More doctors must join nurses, administrators in leading efforts to improve patient safety, outcomes

New superbug genes sure to spread, U.S. expert says

New superbug genes sure to spread, U.S. expert says

From a December 15 Reuters Health News item by Maggie Fox

WASHINGTON (Reuters) – A little loop of genes that give bacteria the power to resist virtually all known antibiotics is spreading quickly and likely to cause doctors headaches for years to come, an expert predicted on Wednesday.

They come on the equivalent of a genetic memory stick — a string of genes called a transmissible genetic element. Bacteria, unlike higher forms of life, can swap these gene strings with other species and often do so with wild abandon.

This one is called New Delhi metallobeta-lactamase 1 or NDM-1 for short and Dr. Robert Moellering of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston predicts it will cause more trouble in the coming years.

“What makes this enzyme so frightening is not only its intrinsic ability to destroy most known beta-lactam antibiotics but also the company it keeps,’ Moellering wrote in a commentary in the New England Journal of Medicine.….

….

Antibiotic-resistant bacteria are nothing new — virtually all strains of the common Staphylococcus bacteria are now resistant to penicillin. Almost as soon as penicillin was introduced in the 1940s, bacteria began to develop resistance to its effects, prompting researchers to develop many new generations of antibiotics.

But their overuse and misuse have helped fuel the rise of drug-resistant “superbugs.” The U.S. Centers for Disease Control and Prevention says most infections that people get while in the hospital resist at least one antibiotic.

[Click here for the CDC Web page on Antibiotic Resistance
It contains detailed information under topics as About Antimicrobial Resistance and Diseases/Pathogens Associated with Antimicrobial Resistance.
References and Resources includes information on campaigns and surveillance systems as well as links to related podcasts, e-cards, and videos.  There are also links to government and organizational Web sites.

KILLER MRSA

For example, half of all Staphylococcus aureus infections in the United States are resistant to penicillin, methicillin, tetracycline and erythromycin. Methicillin-resistant staph aureus or MRSA killed an estimated 19,000 people in the United States alone in 2005.

NDM-1 resists many different types of antibiotic. In at least one case, the only drug that affected it was colistin, a toxic older antibiotic.

“Thus far, the majority of isolates in countries throughout the world can be traced to subjects who have traveled to India to visit family or have received medical care there,” Moellering wrote.

“However, the ability of this genetic element to spread rapidly among Enterobacteriaceae means that there will almost certainly be numerous secondary cases throughout the world that are unrelated to travel to the Indian subcontinent.”

Experts have been warning for years that poor hospital practices and the overuse of antibiotics spread dangerous bacteria, but practices are changing only slowly.

“The fact that there is widespread nonprescription use of antibiotics in India, a country in which some areas have less than ideal sanitation and a high prevalence of diarrheal disease and crowding, sets the ideal stage for the development of such resistance,” Moellering wrote….