Antimicrobial Resistance Poses Rising Threat to Surgical Care

Antimicrobial resistance (AMR) has emerged as a critical public health issue, particularly affecting surgical care, experts warn. Projections indicate that AMR could lead to over 35 million deaths between 2025 and 2050, complicating even routine surgical procedures.

Surgeons express concern that rising antibiotic resistance could undermine decades of safety advancements within surgical practices, increasing the risk of life-threatening post-operative infections. Antibiotics play a crucial role in preventing infections during surgical procedures. However, their misuse contributes significantly to AMR, prompting hospitals to implement stricter stewardship practices focused on infection prevention rather than prolonged antibiotic use.

According to the World Health Organisation (WHO), surgical site infections are prevalent in low- and middle-income countries, affecting up to 11% of patients undergoing surgery. The WHO advises that antibiotics for surgical prophylaxis should be administered before the surgical incision and generally should not be continued post-operatively, as their prolonged use may contribute to resistance without offering additional benefits.

Dr Amarchand Bajaj, a senior consultant in general surgery at the Sitaram Bhartia Institute of Science and Research, stated that modern surgical practices rely on effective antibiotics alongside surgical expertise. He cautioned that resistance complicates treatment for common surgeries such as appendectomy and gall bladder removal, potentially leading to increased complications and longer hospital stays.

Despite misunderstandings among patients and healthcare providers suggesting that increased antibiotic doses lead to better protection, experts advocate for timely and appropriate antibiotic use instead. The emphasis is on correctly timing antibiotic administration and ensuring discontinuation once evidence suggests it is no longer needed. Each unnecessary dose contributes to resistance and poses unnecessary side effects risk to patients.

The presence of multidrug-resistant organisms such as Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) is becoming more common in post-operative infections, complicating infection management further. To prevent infections, surgeons assert that strategies must extend beyond simple antibiotic use. This encompasses optimising patient health prior to surgery, promoting smoking cessation, maintaining strict cleanliness in operating theatres, ensuring proper skin preparation, administering antibiotics at the right time, and encouraging early movement after surgery.

Dr Asuri Krishna, a professor in the surgery department at All India Institute of Medical Sciences (AIIMS) Delhi, echoed these sentiments, indicating that antibiotics cannot replace sound infection-control practices.

Globally, AMR represents a significant burden, with a 2019 analysis published in The Lancet estimating that 1.27 million deaths were directly attributable to bacterial resistance, with an additional 4.95 million associated with drug-resistant infections.

In India, efforts are underway to monitor surgical site infections more systematically. A recent study led by the Indian Council of Medical Research (ICMR) found a surgical site infection rate of 5.2%. This research identified factors such as longer surgeries and contaminated wounds as primary infection risks.

The US Centers for Disease Control and Prevention (CDC) outlines that resistant germs can spread through inadequate infection control, particularly in healthcare settings. Transmission pathways include contact with surfaces, during medical procedures, or through waste. These resistant bacteria in waste can survive in plumbing systems and may re-enter circulation.

To tackle AMR, experts recommend bolstering antimicrobial stewardship programmes in hospitals. This involves promoting evidence-based antibiotic practices, timely administration before surgeries, and ongoing monitoring of prescribing patterns to minimise unnecessary exposure while ensuring patient safety.