Antibiotic resistance potentially threatens the safety and efficacy of surgical procedures and immunosuppression therapies

By Kate Bass, B.Sc.Oct 16 2015

This week The Lancet Infectious Diseases journal published the strongest evidence to date that increasing antibiotic resistance could have disastrous consequences for patients undergoing surgery or cancer chemotherapy. Based on a review of published literature, researchers predict that a 30% reduction in the efficacy of the prophylactic antibiotics routinely given when these procedures are performed could result in 120,000 more infections and 6300 infection-related deaths every year in the USA alone.

It is standard practice to administer antibiotics prophylactically to patients who are vulnerable to infection as a result of surgery or immunosuppressing cancer treatment. Infections in such compromised patients can, at best, seriously hinder recovery, and even be fatal. We regularly hear that bacteria are rapidly becoming resistant to commonly used antibiotics and that action is needed to avoid reaching a critical situation, but the scale of the problem has not be scientifically determined. The latest study conducted at the Center for Disease Dynamics, Washington, USA is the first to quantify the potential risk of rising antibiotic resistance.

The study analysed the number of infections and infection-related deaths in randomised controlled trials examining the efficacy of antibiotic prophylaxis for the ten most common surgical procedures and blood cancer chemotherapy in the USA between 1968 and 2011. National Health Safety Network data were used to identify the proportion of infections that are now resistant to currently used standard prophylactic antibiotics.

It was estimated that nearly half of post-surgery infections, and over a quarter of infections after chemotherapy are caused by bacteria that are already resistant to standard prophylactic antibiotics used in the USA. Alarmingly, up to 90% of infections at the site of transrectal prostate biopsy and more than a quarter (27%) of infections after blood cancer chemotherapy are caused by organisms that are resistant to recommended antibiotics.

Lead researcher, Dr Ramanan Laxminarayan commented:

This is the first study to estimate the impact of antibiotic resistance on broader medical care in the United States. A lot of common surgical procedures and cancer chemotherapy will be virtually impossible if antibiotic resistance is not tackled urgently. Not only is there an immediate need for up-to-date information to establish how antibiotic prophylaxis recommendations should be modified in the face of increasing resistance, but we also need new strategies for the prevention and control of antibiotic resistance at national and international levels.”

The researchers calculated that a reduction in the efficacy of antibiotic prophylaxis by only 10% could result in at least 40,000 additional infections and 2100 infection-related deaths every year in the USA. As the level of antibiotic resistance rises, so do these figures.

Continued increases in microbial antibiotic resistance will mean that in the future it will not be possible to protect patients who need surgery or chemotherapy from life-threatening infections using antibiotic prophylaxis.

Dr Joshua Wolf of St. Jude Children’s Research Hospital, Memphis, USA highlighted:

All clinicians have a responsibility to prevent this situation from becoming our patients’ reality by supporting efforts to combat antimicrobial resistance worldwide and by supporting antimicrobial stewardship at home [using systemic interventions such as clinician education, guideline development, and formulary restriction to optimise antibiotic use]."