Are Antibiotic-Resistant Diseases Mother Nature's Revenge?
The authors then compared the overall rate of blood-borne infections with MRSA between the groups. They found universal decolonization – the prophylactic use of antibacterials regardless of whether or not patients were initially infected – was by far the most effective, with decolonization of those initially infected next best, and the method most widely used around the world -- isolation and special nursing precautions -- the least effective.
One of the reasons for the superior efficacy of universal decolonization might have been that those who were infected with MRSA on admission were disinfected straight away rather than after a delay while laboratory results were awaited, and thus the offending organism had no opportunity to spread in the meantime.
The authors estimated that 54 patients under the scheme of universal decolonization had to be treated in order to prevent one blood-borne infection. The cost of universal decolonization was $40 a head: that is to say, one blood-borne infection was prevented at a cost of $2160. If, as seems likely (though the authors are hesitant on the point), such an infection involves the extra expenditure of more than $2160 per patient, then universal decolonization would lead to economic savings as well as – presumably – to less suffering. (Additional savings would be made by the need for fewer initial laboratory tests.) The trial was not large enough, however, to determine whether any lives would be saved by universal decolonization and if so, how many. It seems to me likely, though, that lives would be saved.
The neo-pagans, however, could take some comfort from a caveat issued by the authors. If universal decolonization were instituted, as seems to be the logical practical consequence of the experiment, the bacteria might develop resistance to the products (chlorhexidine and mupirocin) used to disinfect. Indeed, there is already some evidence that this is happening. Thus victory over bacterial infection is only temporary, not final and probably never to be final, given the genetic flexibility of bacteria; medicine is thus an aspect of Man’s Promethean bargain. But temporary victory is to be preferred to perpetual defeat.
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