Antibiotic resistance emerging as major threat to surgical care: Experts

New Delhi: The growing threat of antimicrobial resistance is making even routine surgical procedures more challenging, with surgeons warning that the loss of effective antibiotics could undermine decades of progress in safe surgery and increase the risk of life-threatening post-operative infections.

Surgeons say that while antibiotics remain critical in preventing surgical site infections, their indiscriminate use has fuelled resistance, forcing hospitals to adopt stricter antibiotic stewardship practices and emphasise infection prevention measures over prolonged antibiotic prescriptions.

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Modern surgery depends as much on effective antibiotics as it does on surgical skill, Dr Amarchand Bajaj, senior consultant for general surgery at the Sitaram Bhartia Institute of Science and Research, said.

"Whether it is an appendectomy, gall bladder surgery or major gastrointestinal surgery, the inability to treat infections due to resistant bacteria can significantly increase complications and prolong hospital stays," Bajaj said.

According to the World Health Organization (WHO), surgical site infections are the most common healthcare-associated infections in low and middle-income countries, affecting up to 11 per cent of patients undergoing surgery.

The WHO's global guidelines recommend that antibiotics for surgical prophylaxis should generally be administered before incision and should not be routinely continued after surgery in most cases, as prolonged use offers little benefit while contributing to antimicrobial resistance (AMR).

Bajaj said the misconception that "more antibiotics mean better protection" continues to persist among both patients and some healthcare settings.

"The objective is not to give antibiotics for several days after surgery but to administer the correct antibiotic at the right time and discontinue it when evidence suggests. Every unnecessary dose contributes to resistance and may expose patients to avoidable side effects," he said.

The challenge is particularly acute as hospitals increasingly encounter multidrug-resistant organisms such as Klebsiella pneumoniae, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) in post-operative infections.

Surgeons say that preventing infections now requires a comprehensive strategy extending well beyond antibiotics.

"Optimising diabetes before surgery, encouraging smoking cessation, maintaining strict operating theatre sterility, proper skin preparation, timely antibiotic administration and early mobilisation after surgery are all equally important in preventing infections. Antibiotics alone cannot compensate for poor infection-control practices," Dr Asuri Krishna, professor in the department of surgery at AIIMS Delhi, said.

Globally, AMR is already exacting a heavy toll. A widely cited analysis published in The Lancet estimated that 1.27 million deaths were directly attributable to bacterial antimicrobial resistance in 2019, while 4.95 million deaths were associated with drug-resistant bacterial infections, making AMR one of the leading public health threats worldwide.

These trends have significant implications for surgical care, where effective antibiotics are indispensable for both preventing and treating postoperative infections, Krishna said.

Dr V K Bansal, professor in the department of surgery at AIIMS Delhi, said that antimicrobial stewardship programmes in hospitals have become central to surgical practice.

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These programmes promote evidence-based antibiotic selection, appropriate timing before surgery, microbiological surveillance and continuous monitoring of prescribing patterns to minimise unnecessary antibiotic exposure without compromising patient safety, he said.

The surgeons also called for greater public awareness, noting that patients often expect antibiotics to continue for several days after surgery despite international guidelines recommending otherwise for most clean surgical procedures.

"As bacteria become increasingly resistant, preserving the effectiveness of existing antibiotics is everyone's responsibility. Every surgeon, every hospital and every patient has a role in ensuring these life-saving drugs remain effective for future generations," Bansal said.

India has also begun systematically tracking surgical site infections.

An ICMR-led multicentric surveillance study involving hospitals across the country found an overall surgical site infection (SSI) incidence of 5.2 per cent.

The study identified longer duration of surgery, contaminated wounds, higher anaesthesia risk scores and complex procedures such as debridement and laparotomy as the major risk factors for infection.

Researchers said the surveillance programme provides one of the first nationwide estimates of the burden of SSIs in India and can help hospitals strengthen their infection-control measures.