Emerging Paradigms in the Prevention of Surgical Site Infection: The Patient Microbiome and Antimicrobial Resistance

Abstract

Summary Statement: This article summarizes new scientific evidence on the pathogenesis of surgical site infection, including the roles of the patient microbiome and antimicrobial resistance, and reviews changes in guidelines and clinical practices for prevention.

Updates in Prevention of Surgical Site Infection: Comment

“…Long et al 1 provided a well-written and accessible review of new ideas in the field of surgical site infection prevention. Within their discussion of the patient’s microbiome, the authors touch on the potential for interactions between the patient microbiome and anesthetic agents administered perioperatively.…”

“…Long et al . 1 cite two mouse model articles where exposure to volatile anesthetics was associated with a decrease in intestinal microbiome diversity. 2,3 In contrast, Guo et al , 4 using a rat model, looked at the effect of a continuous infusion of propofol during a 3-h period on the intestinal microbiome and found little change in the diversity of the intestinal microbiome after exposure to propofol.…”

Updates in Prevention of Surgical Site Infection: Reply

“…We thank Drs. Mundangepfupfu and Nadler for their letter 1 regarding our review, “Emerging Paradigms in the Prevention of Surgical Site Infection,” 2 in which they comment that other common anesthetic medications, beyond those highlighted in the article (volatile agents and opioids), may influence the microbiome or host immunologic response—specifically propofol and ketamine. We agree and thank them for raising this point.…”

The Emerging Paradigm of Antimicrobial Resistance in Surgical Site Infections of the Nilgiris Region

“…15 Similar resistance-related differences in surgical outcomes are anticipated to emerge, or may already exist, in the United States, but have not been studied. 16 Healthcare facilities are unable to receive accurate information about bacteria resistant to antimicrobial medicines due to insufficient SSI surveillance efforts. Antibiotics that are effective are costly and difficult to obtain, hence broadspectrum antibiotics are frequently used which leads to alarming resistance rates.…”