Challenges of Antibiotic Resistance in the Treatment of Postoperative Infections

Abstract

Introduction: Despite improvements in prophylaxis and infection control measures, surgical site infections (SSIs) remain an important cause of nosocomial morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) has become the leading cause of SSI in community hospitals and leads to 15% of SSIs. This review examined the challenges associated with antibiotic resistance in surgical wound infections.
Methods: A literature search of the MEDLINE database was performed, and studies of post-surgical wound infections were included in this review. Keywords used for searches of medical subject headings included: "antibiotic prophylaxis" OR "vancomycin" OR "teicoplainin" AND "surgical procedures" OR "surgical site infections" AND "surgical wound infections." Bibliographies of selected studies and review articles were reviewed to identify additional references. Two independents reviewer screened the included articles and extracted the relevant data about post-surgical infections and antibiotic resistance.
Results: Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. Postoperative surgical site infections remain a major source of illness and a less frequent cause of death in the surgical patient. Infections result in longer hospitalization and higher costs. Most infections are diagnosed and treated in the outpatient clinic or the patient's home. The pathogens isolated from infections differ, primarily depending on the type of surgical procedure. In clean surgical procedures, in which the gastrointestinal, gynecologic, and respiratory tracts have not been entered Staphylococcus aureus from the exogenous environment or the patient's skin flora is the usual cause of infection. In other categories of surgical procedures, including clean-contaminated, contaminated, and dirty, the polymicrobial aerobic and anaerobic flora closely resembling the normal endogenous microflora of the surgically resected organ is the most frequently isolated pathogens.
Conclusions: Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. Many studies have defined the patients at the highest risk for infection in general and in many specific operative procedures.