Infection and Drug Resistance (Dec 2021)
Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice
Abstract
Bradley D Menz,1 Esmita Charani,2,3 David L Gordon,4,5 Andrew JM Leather,6 S Ramani Moonesinghe,7,8 Cameron J Phillips1,4,9 1SA Pharmacy, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia; 2Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; 3National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK; 4Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; 5Division of Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia; 6Centre for Global Health and Health Partnerships, School of Population Health and Environmental Science, Kings College London, London, UK; 7Centre for Perioperative Medicine, UCL Division of Surgery and Interventional Science, London, UK; 8UCL Hospitals NIHR Biomedical Research Centre, London, UK; 9Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, AustraliaCorrespondence: Cameron J PhillipsCollege of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5001, AustraliaTel +61 8 8204 4400Email [email protected]: The increasing incidence of antimicrobial resistance (AMR) presents a global crisis to healthcare, with longstanding antimicrobial agents becoming less effective at treating and preventing infection. In the surgical setting, antibiotic prophylaxis has long been established as routine standard of care to prevent surgical site infection (SSI), which remains one of the most common hospital-acquired infections. The growing incidence of AMR increases the risk of SSI complicated with resistant bacteria, resulting in poorer surgical outcomes (prolonged hospitalisation, extended durations of antibiotic therapy, higher rates of surgical revision and mortality). Despite these increasing challenges, more data are required on approaches at the institutional and patient level to optimise surgical antibiotic prophylaxis in the era of antibiotic resistance (AR). This review provides an overview of the common resistant bacteria encountered in the surgical setting and covers wider considerations for practice to optimise surgical antibiotic prophylaxis in the perioperative setting.Keywords: antibiotic resistance, perioperative care, surgical antibiotic prophylaxis, surgical site infection, antimicrobial stewardship
