It has long been a basic assumption of modern surgery that effective antibiotics will be available when needed, but antimicrobial resistance (AMR) is challenging that belief. Gian C. Mendiola Barrios, MD, FACS, a general surgeon in Lima, Peru, will moderate a session at ACS Clinical Congress that examines the growing threat of AMR.
Join Dr. Mendiola and a panel of experts for “Surgical Site Infections and Antimicrobial Resistance: Are We Losing the Fight?” (PS313) today at 9:45 am. The session will be co-moderated by Walter J. Robles Valverde, MD, FACS, and will feature presentations by Robert G. Sawyer, MD, FACS, from Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo, and E. Patchen Dellinger, MD, FACS, from the University of Washington in Seattle.
Although AMR is often discussed as a broad public health threat, it’s becoming a particularly urgent concern for surgeons.
“Surgical site infections (SSI) are not simply an infectious-disease problem,” Dr. Mendiola said. “They can mean a failed operation, a reoperation, prolonged hospitalization, sepsis, or even death.”
Emergency and contaminated abdominal procedures, colorectal and other high-risk gastrointestinal operations, prolonged procedures, and open surgeries are particularly vulnerable to SSI, as are patients with recent hospitalization or antibiotic exposure, significant comorbidities, prolonged preoperative stays, or possible colonization with resistant organisms.
The warning signs are often visible before the operation begins, and the challenge for surgeons is recognizing the risks early enough to influence prevention and empiric treatment without automatically giving every patient broader-spectrum antibiotics.
“The question is not simply ‘Which antibiotic should I give?’” Dr. Mendiola said. “It is ‘Which patient in front of me is actually at risk for a resistant organism?’”
Responding with broader or longer antibiotic coverage may accelerate the very resistance surgeons are trying to combat. Therefore, surgeons must think about infection prevention, antibiotic selection, source control, and stewardship as parts of the same problem. The challenge is magnified in hospitals, regions, and countries with fewer resources. When microbiology capacity and surveillance are lacking, it is harder to assess the resistance patterns and easier to rely on broad empiric therapy. International data increasingly show that microbiology capacity itself is a critical component of surgical quality and antimicrobial stewardship.
Dr. Mendiola said the session will explore the tension between rapid empiric treatment and stewardship, including when broader prophylaxis may be justified, when it is not, how local resistance data should influence decisions, and how source control and infection prevention fit into the equation. At the heart of that discussion is a fundamental question: Are surgeons fighting infections in a way that protects patients today without compromising the ability to treat them tomorrow?
“One of the most uncomfortable questions is whether more antibiotics actually mean safer surgery,” he said. “When a surgeon faces a critically ill patient with a potentially resistant infection, waiting for cultures may not be an option, but indiscriminate escalation of antibiotics can further drive resistance.”
Dr. Mendiola hopes attendees will leave the session understanding that resistance is not something to discover after the culture comes back; it is something to anticipate before and during the operation. The panel will discuss how surgeons can recognize patients at increased risk, understand their institution's resistance patterns, obtain appropriate cultures, choose empiric therapy intelligently, and reassess antibiotics when microbiologic information becomes available.
“We want surgeons to leave with a different way of thinking about postoperative infection,” he said. “Most importantly, they should recognize that preventing the infection is our most powerful antimicrobial-stewardship intervention.”
AMR is increasingly affecting surgical care around the world, but the organisms responsible for surgical infections and their resistance patterns can vary substantially between hospitals, regions, and countries. As a result, an empiric regimen that is appropriate in one institution may be inadequate, or unnecessarily broad, in another.
This session will be made available for on-demand viewing shortly after the live presentation.
