Giving antibiotics to patients in hospital intensive care units (ICUs) to prevent—rather than fight—bacterial infections may reduce the number of patient deaths, Dutch scientists report today in The New England Journal of Medicine. Despite the findings, some researchers remain skeptical whether the possible risks (most notably spurring new antibiotic-resistant germs) outweigh the benefits of plying patients with antibiotics instead of using other more benign strategies such as hand-washing, isolating contagious patients and scrubbing hospitals with antiseptic cleansers.
Antibiotics are routinely given to patients before and after certain surgeries to ward off potential infection when the body is in a weakened condition. But this is one of the largest studies to show that giving all critically ill patients antibiotics may be advantageous as well.
Epidemiologist Neil Fishman, director of the University of Pennsylvania's infection control division, calls this the "best study" to date on the issue. But Fishman and other experts warn against widespread use of prophylactic antibiotics. There has been "a more consistent demonstration of benefit with the surgical use of prophylactic antibiotics, [but] I don't think the evidence is completely clear yet for ICUs," says Michael Bell, an infectious disease expert at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, Ga.
Researchers studied 6,000 patients in 13 hospitals across the Netherlands, who spent at least two days on a ventilator or three days in the intensive care unit. They found that antibiotics cut their risk of death by up to 3.5 percent.
But infectious disease experts caution that what works in the Netherlands, which leads the world in controlling antibiotic-resistant superbugs, may not work in other places like the U.S. where the problem is more serious.
"The drugs used in this study might or might not kill a multidrug resistant organism," which are far more prevalent in U.S. hospitals, says William Jarvis, an epidemiologist and former head of the Investigation and Prevention branch of the CDC's Hospital Infections Program.
In addition, Fishman says, the antibiotics themselves may trigger bugs that may become immune to drugs to which they are constantly exposed.
"Anytime you give an antibiotic, you need to be concerned about the emergence of [antibiotic] resistance," he says. "This study was not big enough and long enough to detect that."
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