October 16, 2015
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Growing antibiotic resistance threatens surgical procedures, chemotherapy

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A significant portion of pathogens responsible for surgical site infections and infections after immunosuppressing chemotherapy are resistant to standard prophylactic antibiotics, according to estimates from a recently published literature review.

In addition, an antibiotic prophylaxis efficacy reduction of 30% could result in 120,000 additional annual SSIs and other infections after chemotherapy, and 6,300 infection-related deaths in the United States, according to Aude Teillant, MS, of the department of ecology and evolutionary biology at Princeton University, and colleagues.

“Antibiotics are integral to modern health care and have enabled the use of invasive surgical or immunosuppressive medical procedures that depend on the ability to keep the body free of infection,” the researchers wrote. “Increasing antibiotic resistance threatens the efficacy of these procedures and could result in adverse clinical outcomes, including increased rates of morbidity, amputation or death.”

Teillant and colleagues performed a literature review of meta-analyses and randomized controlled trials regarding the efficacy of antibiotic prophylaxis. Data focusing on infections after surgery and chemotherapy and antibiotic prevention were included for 10 of the most commonly performed procedures and chemotherapy. Using information obtained from the CDC and National Cancer Data Base, effect sizes identified from the literature were applied to estimate annual infection rates throughout the U.S. These data also were used to predict the consequences of further reductions in antibiotic prophylaxis efficacy.

There were 292 randomized controlled trials included in the analysis, nearly all of which were a part of 10 identified meta-analyses meeting the researchers’ criteria. The estimated proportion of SSIs caused by resistant pathogens ranged from 38.7% (cesarean section, hysterectomy) to 50.9% (pacemaker implantation) depending on the procedure, while 26.8% of infections after chemotherapy were attributed to antibiotic resistance. Based on this, researchers calculated that a 30% reduction in the efficacy would result in 120,000 additional infections and 6,367 deaths per year in the U.S. The researchers wrote that a large portion of these additional infections would be attributable to frequently performed procedures with low infection rates such as cesarean section and transrectal prostate biopsy, but the additional deaths would result from colorectal surgery, blood cancer chemotherapy and total hip replacement.

“The reduction in the ability to safely undertake common surgical procedures and cancer chemotherapy could lead to a fall in the frequency of such procedures, yielding an indirect increase in noninfectious morbidity and mortality,” Teillant and colleagues wrote. “More data are needed to assess the degree of antibiotic resistance in pathogens that cause SSIs or infections after cancer treatments in different settings.”

In a related editorial, Joshua Wolf, MBBS, of the infectious disease department at St. Jude Children’s Research Hospital, explained that these findings underline the importance of practices that reduce the development of antibiotic resistance, such as vaccines, infection control, personalized regimens and antimicrobial stewardship.

“Teillant and colleagues describe a future in which patients who need surgery or chemotherapy can no longer be protected from life-threatening infections by antibiotic prophylaxis,” he wrote. “All clinicians have a responsibility to prevent this situation from becoming our patients’ reality by supporting efforts to combat antimicrobial resistance and by supporting antimicrobial stewardship at home.” – by Dave Muoio

Disclosures: Teillant reports support from the Department of Homeland Security. Wolf reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.