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


According to researchers from Columbia University Medical Center, New York City, these result findings may reassure surgeons who abstained from ordering a short-course of antibiotics before patients surgical procedures since concerned about breeding antibiotic resistance.

There are clear guidelines about the use of prophylactic antibiotics to prevent surgical site infections from surgical, infectious disease, epidemiological, and pharmacy specialty societies. Which covered major cover 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, before performing other types of operations, the administration of prophylactic antibiotics left to the discretion of the surgeon. The principal author of the study Freedberg said, "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. Therefore, 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 antibiotic resistance and bacterial infections that have no or almost no treatment options."

Dr Freedberg and his associates assessed the use of surgical antibiotic prophylaxis and the development of postoperative antibiotic-resistant infections across a wide range of operations for which there is no specialty society guidelines relationship.

Between 2008 and 2016 the researchers reviewed all 22,138 patients (age=18) who had one of these operations. Those patients who developed (if they had a favorable bacterial culture from any surgical site or fluid specimen) an infection within 30 days of the operation. The cut-off time was set at 30 days assuming that the effect of antibiotics on resistance would wane over time.

Researchers determined prophylactic antibiotics received patients, and those who received any class of antibiotic at any dose, anytime, from one hour before the first surgical incision until the end of the operation were included in their assessment.

A total of 689 patients (3.1 %) developed an infection within 30 days, and within that group 550 (80 %) had received antibiotic prophylaxis, and 338 (49%) had an infection resistant to antibiotics, in this study. Patients, whether received prophylactic antibiotics or not also, they had the same risk of developing an antibiotic-resistant infection. Patients (47%) with a resistant infection had no antibiotic prophylaxis compared with those who did have prophylaxis.

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