Is there a threat of antibiotic resistance for surgical and chemotherapy patients.

logo1267406_mdA new study published in the Lancet Infectious Disease Journal concluded that the rising antibiotic resistance could have disastrous consequences for patients receiving surgery or cancer chemotherapy.  New estimates show that up to half of infections following surgery and over a quarter of those following chemotherapy are caused by organisms already resistant to standard prophylactic antibiotics in the United States. They further say that just a 30% reduction to the efficacy of preventive antibiotics that are given routinely before, during, and after these procedures could result in 120,000 more infections and 6300 infection-related deaths every year in the United States.  Although bacterial resistance was known, it extent was unknown previously.

Researchers conducted a review of all meta-analyses of randomized control trials conducted between 1968 and 2011. They examined the efficacy of antibiotic prophylaxis in preventing infection-related deaths after 10 of the most common surgical procedures and blood cancer chemotherapy and calculated the additional number of infections and infection0related deaths under different scenerious of reduction in the efficacy of antibiotic prophylaxis. In addition, they use data and existing studies from the National Health Safety network they estimated the proportion of infections caused by bacteria that are resistant to currently used standard prophylactic antibiotics., They found that between 39% (after caesarean section)and 50-90% (after trans-rectal prostate biopsy) of surgical site infections are caused by organisms that are  resistant to recommended antibiotic prophylactic regimes. Also, just over a quarter of the infections after blood cancer chemotherapy are resistant to standard antibiotics. Using additional modelling they estimated that a 10% drop in the efficacy of antibiotic prophylaxis could result in 40,000 additional infections every year in the United States at best. or 280,000 infections in a pessimistic scenerio –a 70% drop in efficacy.  They also concluded the infection-related deaths could increase by 2100in an optimistic scenerio. or even a 15,000 deaths in a pessimistic scenerio. They concluded that clinicians have a responsibility to prevent this from happening by clinician education, guideline development, and formulary restrictions to optimize antibiotic use.

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