The story centers the majority of its attention on a single study, providing little comment on an accompanying editorial and on a second study published in the same issue of the New England Journal of Medicine. And the one that got less attention was perhaps more important, as supported by the accompanying editorial. A summary of both papers and more of the "take-home messages" from the editorial and would have provided readers with a more complete view of the potential approaches to reducing post-operative infections.
The story used only 429 words. A few more would have addressed our concerns.
Hospital-acquired surgical infections are a major source of morbidity and mortality. Despite an increasing number of available antibiotics, post-operative wound infections continue to be a substantial problem. The prophylactic use of mupirocin has been reported to be of value in reducing wound infection in carrier patients undergoing orthopedic and cardiac surgical procedures. However, the practice of routinely screening patients for the presence of Staphylococcus aureus has not been generally adopted in US hospitals. This study’s demonstration of the value of a rapid screening test and of routine prophylactic use of mupirocin along with a chlorhexidine scrub is an important finding.
The story does not adequately discuss costs, an important consideration. Cost benefits are briefly mentioned. But those cost-saving implications are not validated in any way in the story. And no estimates of absolute costs were disclosed. Independent assessment of the cost implications would have been preferable.
The potential benefits are quantified. We were pleased to read absolute risk reduction data following the relative risk reduction data.
The potential harms of the drugs, potential false positives from screening, deaths during the study, and impact of such a prophylactic protocol on antibiotic resistance are not discussed.
The study publication mentions adverse reactions due to local irritation of the nose or skin, which resolved after treatment was discontinued.
We believe harms always warrant at least a brief mention.
The article mentions the large number of subjects, placebo control group, and the peer-reviewed presentation of the data. It implies treatment randomization.
The story could have provided a bit more detail on the methods for this study, and more importantly for the second study. The accompanying editorial is important in its assessment and should have been discussed more completely in the story. The comments in the story relative to the editorial appear to miss the central point: of the two interventions, the use of chlorhexidine-alcohol appears to be preferable for the majority of patients.
Nonetheless, we’ll give the story the benefit of the doubt on this criterion.
In general, the article does not appear to exaggerate this problem.
The only source cited outside of study authors is Dr. Richard Wenzel’s quote from his NEJM editorial regarding his opinion on the primary uses of the new technique. We might have graded this satisfactory – although barely – were it not for the following omission.
Conflicts of interest were not identified. As reported in the NEJM article, the study was supported by grants from GSK and Molnlycke, the drug companies that make the treatments used in the study, Bactroban and Hibiscrub.
This question was not addressed in the story. The reality is that there is no routinely applied standard of practice related to routine surgery. While antibiotics are routinely administered early during a surgical procedure, patient preparation is not standardized.
Availability is not discussed. The story should have noted that the resources used in the Bode study are currently available in US hospitals, just not routinely applied. We think this should have been noted in the story.
In our opinion, the story misses an obvious emphasis – that the drugs and the diagnostic test in question are routinely available, yet their use is not routine in US hospitals. Neither the diagnostic test nor the interventions are new. Yet the story doesn’t give us a good sense of that.
The article does not appear to be based on a news release.