Antibiotics before low-risk operations do not seem to breed postop antibiotic resistance

October 10, 2017, American College of Surgeons

Surgical patients who receive antibiotics before certain types of low-risk operations are not at an increased risk for antibiotic-resistant infections immediately after their procedures, according to results from a large-scale study conducted by researchers from Columbia University Medical Center, New York City. These findings may reassure surgeons who refrain from ordering a short-course of antibiotics prior to patients' surgical procedures because of concerns about breeding antibiotic resistance. Study results appear as an "article in press" on the Journal of the American College of Surgeons website in advance of print.

Surgical, infectious disease, epidemiological, and pharmacy specialty societies have clear guidelines about the use of to prevent surgical site infections. These guidelines cover major operations of all types, including cardiothoracic, abdominal, head and neck, neurological, obstetric, orthopedic, transplantation, and ophthalmic procedures, and make recommendations about timing, selection, dosing, and duration of antibiotic administration.

However, the administration of prophylactic is left to the discretion of the surgeon before performing other types of operations. "Guidelines don't comment on relatively straightforward procedures, including some general surgical procedures, simple or diagnostic laparoscopy, or elective orthopedic, gynecologic, and urologic procedures because there has not been enough evidence about their benefit. So some surgeons feel strongly that antibiotics are beneficial and always give them. Others never give them because of concern about the use of antibiotics and the later development of and bacterial infections that have no or almost no treatment options," said Daniel Freedberg, MD, MS, principal author of the study and a specialist in internal medicine.

Dr. Freedberg and his associates at Columbia University Medical Center assessed the relationship between the use of surgical and the development of postoperative antibiotic resistant infections across a wide range of operations for which there are no specialty society guidelines.

The researchers reviewed all 22,138 patients over the age of 18 who had one of these operations between 2008 and 2016. From this overall population, the investigators selected for study those patients who developed an infection within 30 days of the operation. Patients were included in this study if they had a positive bacterial culture from any surgical site or fluid specimen. The cut-off time was set at 30 days assuming that the effect of antibiotics on resistance would wane over time.

The researchers then determined how many patients with an infection had received prophylactic antibiotics. Their assessment included patients who received any class of antibiotic at any dose, any time, from one hour before the first surgical incision until the end of the operation.

Patients were considered to have an antibiotic-resistant infection if bacteria isolated in culture were only moderately susceptible or not at all susceptible to treatment within one or more major antibiotic classes.

In this study, a total of 689 patients (3.1 percent) developed an infection within 30 days, and within that group 550 (80 percent) had received antibiotic prophylaxis, and 338 (49 percent) had an infection resistant to antibiotics.

According to study findings, patients had the same risk for developing an antibiotic-resistant infection whether they received prophylactic antibiotics or not. Forty-seven percent of patients with a resistant infection had no antibiotic prophylaxis compared with 49 percent of those who did have prophylaxis.

The risk was the same regardless of other factors: whether antibiotics were given as soon as one hour or as long as four hours before procedures, whether the follow-up period was shortened from 30 to 14 days after procedures, and whether patients had prior exposure to antibiotics or a prior culture-proven infection.

The only factor associated with a higher risk for postoperative antibiotic-resistant infection was a previous antibiotic-resistant infection.

"If you're trying to figure out as a surgeon whether your patients may later develop a resistant infection in the postoperative period, the best clue is past history of resistant infection," Dr. Freedberg explained.

"The results of this study should be reassuring for those surgeons who choose to use antibiotic prophylaxis believing that antibiotics decrease the overall risk for infection following surgery. The study shows that even if develop an , they will not be worse off because they received a single dose of an antibiotic," concluded Dr. Freedberg.

Explore further: Antibiotic reduces infection risk in young leukemia patients

More information: Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections, Journal of the American College of Surgeons (2017). dx.doi.org/10.1016/j.jamcollsurg.2017.08.010 , www.journalacs.org/article/S10 … (17)31772-6/fulltext

Related Stories

Antibiotic reduces infection risk in young leukemia patients

September 14, 2017
St. Jude Children's Research Hospital researchers have identified an antibiotic that significantly reduced the odds of infections in children starting treatment for acute lymphoblastic leukemia (ALL) without an apparent increase ...

Antibiotics for dental procedures linked to superbug infection, study shows

October 6, 2017
Antibiotics prescribed by dentists may contribute to the growing problem of Clostridium difficile (C. diff), a serious and potentially deadly infection that causes severe diarrhea, suggests research presented at IDWeek 2017. ...

Children with asthma are being prescribed unnecessary antibiotics

September 11, 2017
Children with asthma are more likely to be prescribed antibiotics even though there is no evidence that they need them any more than children without asthma, according to research to be presented at the European Respiratory ...

Antibiotics before heart surgery protect against infection

December 23, 2013
A new study found preoperative antibiotic therapy administered within two hours of cardiac surgery decreased the risk of developing surgical site infections (SSIs) significantly. The study was published in the January issue ...

Antibiotics following C-section among obese women reduces risk of surgical infection

September 19, 2017
Among obese women undergoing cesarean delivery, a postoperative 48-hour course of antibiotics significantly decreased the rate of surgical site infection within 30 days after delivery, according to a study published by JAMA.

Recommended for you

Cold open water plunge provides instant pain relief

February 12, 2018
A short, sharp, cold water swim may offer an alternative to strong painkillers and physiotherapy to relieve severe persistent pain after surgery, suggest doctors in the journal BMJ Case Reports.

Study spotlights risks in anesthesiologist handoffs

February 9, 2018
Most patients are totally unaware that the anesthesiologist who put them under for surgery might not be the same one who brings them out even though that 'handoff' between the two doctors has been linked to a series of negative ...

One in five older adults experience brain network weakening following knee replacement surgery

February 7, 2018
A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive ...

New algorithm decodes spine oncology treatment

February 6, 2018
Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain.

Patients and doctors often disagree in evaluation of surgical scarring

February 1, 2018
When it comes to the physical scars surgery leaves behind, a new study shows patients and doctors often don't assess their severity the same way. Researchers from the Perelman School of Medicine at the University of Pennsylvania ...

Boosting a key protein to help bones that won't heal

February 1, 2018
When a patient breaks a bone, there's a possibility the fracture won't heal properly or quickly—even with the aid of pins, plates or a cast.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.