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Nosing Out Infection

Applying an antibiotic to the noses of some surgery patients can sharply reduce their risk of developing a nasty wound infection, according to a study published in Thursday's New England Journal of Medicine.

Doctors discovered years ago that if surgery patients harbored the bacterium Staphylococcus aureus in their nasal cavities, their risk of developing a wound infection was up to nine times greater than those who did not carry the germ in their noses. Treating such infections costs between $5 billion and $10 billion annually in the United States.

Researchers reported in the Journal that applying an antibiotic, mupirocin, to eliminate the bacteria from the noses of surgery patients could cut the risk of wound infection nearly in half.

Dr. Trish Perl of Johns Hopkins Medical Institutions in Baltimore, the study's chief author, said the findings "carry tremendous implications" for preventing hospital infections "and for preventing illness and saving lives."

The bacterium is normally found in the noses of 25 to 30 percent of patients in hospitals and usually causes little harm, but it can cause serious problems if it contaminates wounds -- especially among people whose immune systems have been weakened. Bacteria from the nasal cavities can infect other areas of the body, although researchers did not speculate how the bacteria manage to travel to the operation site.

Among the 891 people in the Perl study that had the bacterium in their noses, the wound infection rate was 4 percent for those treated with mupirocin, compared with 7.7 percent for patients receiving a placebo ointment.

The ointment is sold under the brand name Bactroban Nasal by GlaxoSmithKline, which paid for the study.

Perl cautioned that bacteria may develop a resistance to the drug if it is overused, although no evidence of resistance was found in her study.

The study also said treatment with the ointment mupirocin was found to have no effect on the risk of infection among patients whose nostrils did not harbor Staphylococcus aureus in the first place. The research was carried out from 1995 to 1998 at the University of Iowa Hospitals and Clinics, and Iowa City's Veterans Affairs Medical Center.

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