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Emerging multiresistant strains: recommended precautions in the emergency room and surgical setting
1University of Nebraska Medical School, Omaha, USA.
Abstract:
The current success in treatment of surgical site infections may be jeopardized by the continued emergence of antibiotic resistance in bacteria common to these infections. The effectiveness of vancomycin against methicillin-resistant staphylococci may decrease as more cases of VISA emerge. No currently available antimicrobial is consistently effective against certain strains of VRE and the potential emergence of VRSA. Orthopaedic surgeons soon may be in the undesirable position of having to eradicate organisms resistant to all available antibiotics. Several new antibiotics show promising activity and may be useful against these multidrug-resistant bacteria. However, as the history of bacterial resistance has taught us, it likely only will be a matter of time until these organisms adapt mechanisms of resistance to these new drugs. The key then lies, as it always has, in preventive measures. Surgeons, and all physicians, must adhere to the precautionary guidelines recently set forth by the CDC and HICPAC. Chief among these guidelines is the elimination of inappropriate antibiotic usage, especially inappropriate vancomycin use.
Insights
Antibiotic resistance in surgical site infections threatens treatment success. Preventing resistance through judicious antibiotic use, especially vancomycin, is crucial for future patient care.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopaedic Surgery
Background:
- Emerging antibiotic resistance in bacteria causing surgical site infections (SSIs) poses a significant threat to current treatment efficacy.
- Specific concerns include vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-resistant Enterococci (VRE), and vancomycin-resistant Staphylococcus aureus (VRSA).
- These resistant strains may leave orthopaedic surgeons with limited or no effective antibiotic options for treating SSIs.
Purpose of the Study:
- To highlight the growing threat of antibiotic resistance in SSIs.
- To emphasize the potential clinical challenges posed by multidrug-resistant organisms.
- To advocate for preventive strategies, particularly the appropriate use of antibiotics.
Main Methods:
- Review of current literature on antibiotic resistance patterns in SSIs.
- Analysis of the clinical implications of emerging resistant bacterial strains.
- Discussion of recommended guidelines for infection control and antibiotic stewardship.
Main Results:
- The effectiveness of current antibiotics, including vancomycin, is increasingly compromised by resistant bacterial strains.
- New antibiotics show promise but are likely to face eventual resistance.
- Preventive measures, guided by CDC and HICPAC, are paramount.
Conclusions:
- The emergence of antibiotic resistance, including VISA, VRE, and VRSA, jeopardizes SSI treatment.
- Judicious antibiotic use, particularly reducing inappropriate vancomycin application, is essential.
- Adherence to infection control guidelines is critical to mitigate the impact of multidrug-resistant bacteria in surgical settings.