• U.S.

Medicine: Cooling the Hot Staph

3 minute read

Almost as fast as new antibiotics are marketed, there evolve a few strains of disease-causing microbes that are resistant to the most potent germ killers. Recently, thanks largely to overuse and outright abuse of favorite antibiotics—especially penicillin—it has seemed that medical scientists were fighting a losing battle (TIME, March 24, 1958 et seq.). Now British researchers report that the microbes’ advance can be checked by rigorously restricting the use of common antibiotics, and imposing the strictest discipline on doctors and nurses.

The enemy in this case (as in most U.S. outbreaks of in-hospital infection) were resistant strains of the common Staphylococcus aureus, usually found in boils and infected wounds. Scene of the counterattack was London’s huge Hammersmith Hospital. By late 1957 no less than 88% of Staph aureus cultures there were resistant to penicillin, 82% to tetra-cyclihe, and 70% were immune to attack by a combination of the two drugs. Then Dr. Mary Barber, 48, a topflight bedside bacteriologist, and her anti-staph team went into action.

On seven wards they put an outright ban on all the most cherished antibiotics (penicillin, streptomycin, three tetracyclines, chloramphenicol, erythromycin and novobiocin) unless the doctors could show that one of these drugs was unquestionably the best for the patient’s disease. Then they had to give their first-choice antibiotic in combination with a second, to cut down the microbes’ chance to develop resistance. Penicillin, as the drug previously most abused, was put under special restrictions: on some wards it could not be given at all, and when used, it had to be injected on a side ward—and from a cartridge syringe to keep it from being sprayed into the air.

Reduction in the overall number of staph infections picked up by patients after they got to the hospital was slight, Dr. Barber concedes in the British Medical Journal, but in little more than a year two notable gains were chalked up: the severity of the infections declined, and the proportion of staph infections that could be knocked out with penicillin and tetracycline increased dramatically. In general, though no hard and fast conclusion could be drawn, resistance and virulence went together; the more vulnerable microbes, which became predominant as the study progressed, also caused less severe disease.

Physicians have long suspected that drastic measures like the code of Hammersmith might halt the advance of resistant “hot” staph, but no such sweeping trial (involving 452 staph infections in 5,239 patients) had been made before. The Hammersmith team concludes confidently that by these means, along with old-fashioned hygiene, antisepsis and asepsis (TIME, Oct. 12), the hot staph can be checked.

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