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    • In summary present evidence suggests that

    2023-05-15

    In summary, present evidence suggests that antimicrobial therapy for intra-abdominal sepsis can be shortened in patients exhibiting a clinical response to treatment. Hence, clinicians should use the resolution of clinical signs of infection as a guide to determine when during the 4–7-day window antimicrobial therapy should be terminated. In practical terms, this usually means treatment can be terminated when the patient is afebrile, has normal WBC counts, and is able to tolerate an oral diet. The profound impact of antibiotic resistance on a surgical patient was described by the CDC in a 2016 report of a woman who had broken her right leg during a trip to India, She struggled with repeated right hip infections while there; after her return to the U.S., she was admitted to a hospital in Reno, Nevada, for progressing infection. Carbapenem-resistant Enterobacteriaceae (CRE) bacteria was isolated and was resistant to all 26 available miniprep mg including polymyxin. With no effective antibiotics available, she eventually developed septic shock and died. Surgeons should obtain a history of health care exposures outside their region upon admission and consider screening for CRE when patients report recent exposure outside the United States or in regions of the United States known to have a higher incidence of CRE.
    Risk of morbidity and mortality Antibiotic prophylaxis is the standard practice for many surgical procedures because studies show it prevents morbidity and mortality. Nelson et al. showed that for every 75 colorectal surgeries performed, antibiotic prophylaxis prevents about 20 SSI and one death. The impact of antibiotic resistance on the efficacy of prophylaxis cannot be overstated. For surgeons, the loss of effective antibiotic prophylaxis increases the risk of infectious complications, which may occur in patients undergoing surgery. Surgical infections can threaten recovery from operative procedures as they cause additional morbidity and mortality. The potential consequences of increases in antibiotic resistance on the 10 most common surgical procedures that rely on antibiotic prophylaxis were investigated. The proportion of SSI caused by pathogens resistant to standard prophylactic antibiotics postcolorectal surgery and transrectal prostate biopsy ranges from 43% to 50–90%, respectively. Figure 1 shows the number of additional infections per year in the USA for four scenarios of 10%, 30%, 70%, and 100% reduction in efficacy of antibiotic prophylaxis. The greatest overall impact is seen in colorectal surgery. If there is a 30% reduction in prophylactic antibiotic efficacy, the predicted number of additional infections for colorectal surgery and transrectal prostate biopsy is 22,500 additional wound infections per year and 17,100 additional urinary tract infection per year respectively. Antibiotic prophylaxis not only prevents SSI, antibiotic but also reduces mortality. Figure 2 shows the number of additional deaths per year in the USA under the same four scenarios of decreased antibiotic prophylaxis efficacy. The highest number of additional deaths is predicted in patients undergoing colorectal surgery. With a 30% reduction in antibiotic prophylactic efficacy, an additional 4586 deaths per year is predicted. In summary the reduction in the ability to safely perform common surgical procedures may lead to a fall in the frequency of such procedures.
    Risk of antibiotic-associated adverse drug events Overprescribing of antibiotics by surgeons occurs for many reasons. In an effort to understand this better, the antibiotic prescribing practices of surgeons at The Johns Hopkins Hospital was recently evaluated. Using the American College of Surgeons National Surgical Quality Improvement Program database, patients who developed health care-associated infections within 30 days of colorectal surgery were identified. The antibiotic selection and duration deviated from the recommended practice in 73% of cases. Over 60% of patients were treated with a prolonged duration of therapy and 25% received too broad a regimen.