Bacteria Lurking In Nose Can
Cause Serious Infections

NEW YORK (Reuters Health) - Staphylococcus aureus bacteria that live in the nose can enter the bloodstream and cause serious, life-threatening infections in some people, researchers report.
S. aureus is one of the most common causes of serious infections that patients acquire while hospitalized, and previous studies have linked the presence of the bacteria in the nose to the risk of such infections. About 60% of people in the population carry the bacteria in their nose at one time or another, and it is usually symptomless.
However, a new study of 219 hospital patients with infections involving S. aureus found that in 82% of cases, the bacteria invading the blood were identical to the bacteria in the patient's nose. The more invasive infections got their start in a number of different ways, including the use of a catheter or the development of skin or respiratory infections.
In a separate analysis of 1,278 hospital patients known to have S. aureus living in the nose, 12 people eventually developed serious blood infections with S. aureus that exactly matched the type of bacteria seen in their nose. The findings are published in the January 4th issue of The New England Journal of Medicine.
Based on these findings, Dr. Christof von Eiff from the University of Munster, Germany, and colleagues conclude that eliminating the bacteria from the nose of hospital patients might prevent serious infections by these same bacteria.
However, this may not be as easy as it sounds, Dr. Gordon L. Archer, of the Medical College of Virginia at Virginia Commonwealth University in Richmond, told Reuters Health.
``The problem is that there is no timely way for identifying these carriers,'' he said. ``If we had a rapid diagnostic test--like the one we have for strep throat--then we might be able to identify people in the hospital with (S. aureus) in their nasal passages and go about eliminating it before serious infections developed.''
Also, it is not clear exactly how to get rid of the bacteria once they are detected, Archer and colleague Dr. Michael Climo note in an editorial accompanying the study. Oral antibiotics may encourage the bacteria to become resistant to such drugs. Giving antibiotic ointment has been unsuccessful or only eradicated the bacteria for short periods of time, or has resulted in resistant bacteria in areas with heavy usage, Archer and Climo explain.
To truly reduce hospital infection due to S. aureus will require ``aggressive tactics and innovative strategies,'' the editorialists conclude. And an attack on the bacteria lurking in the nose should ``be one of the foundations of this program.''
The study was funded in part by SmithKline Beecham, which manufacturers an antibiotic ointment.
SOURCE: The New England Journal of Medicine 2001;344:11-16, 55-56.

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