Related Experiment Video
Updated: Nov 18, 2025
Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes
Published on: April 19, 2024
Surgical antibiotic prophylaxis in patients colonized with multidrug-resistant Gram-negative bacteria: practical and
Elizabeth Temkin1, Ili Margalit1,2, Amir Nutman1,2
1National Institute for Infection Control and Antibiotic Resistance, Ministry of Health, Israel.
Abstract:
Antibiotic resistance threatens the effectiveness of surgical antibiotic prophylaxis (SAP) regimens aimed at preventing surgical site infection (SSI). With a focus on procedures in which Gram-negative bacteria (GNB) are the main pathogens causing SSI, this review summarizes the evidence and describes how SAP must evolve in response to carriage of MDR GNB among surgical patients. Randomized controlled trials of SAP for carriers of resistant GNB require prohibitively large sample sizes. No professional guidelines address the topic of adapting SAP for known carriers of resistant GNB. For patients whose carrier status is unknown, the effects of different SAP strategies have been studied for transrectal ultrasound-guided prostate biopsy and colorectal surgery. The four possible strategies for SAP in the era of antibiotic resistance are: no SAP; universal standard SAP; pre-surgical screening for carriage of antibiotic-resistant pathogens before surgery and targeted SAP (i.e. broad-spectrum antibiotics only for those who screen positive); and universal broad-spectrum SAP. The prevalence of carriage determines the efficiency of each strategy. Decolonization is a potential adjunct to SAP.
Insights
Antibiotic resistance necessitates evolving surgical antibiotic prophylaxis (SAP) to prevent surgical site infections (SSI). Strategies must adapt to multidrug-resistant Gram-negative bacteria (MDR GNB) carriage in patients.
Area of Science:
- Infectious Diseases
- Surgical Sciences
- Microbiology
Background:
- Antibiotic resistance poses a significant threat to the efficacy of surgical antibiotic prophylaxis (SAP).
- Multidrug-resistant Gram-negative bacteria (MDR GNB) are increasingly implicated in causing surgical site infections (SSI).
- Current SAP guidelines do not adequately address the challenge of MDR GNB carriage in surgical patients.
Purpose of the Study:
- To review the evidence on adapting SAP strategies in response to MDR GNB carriage.
- To explore potential SAP approaches for preventing SSI caused by resistant Gram-negative bacteria (GNB).
Main Methods:
- Literature review focusing on SAP for procedures where GNB are primary SSI pathogens.
- Analysis of four potential SAP strategies in the context of antibiotic resistance.
- Consideration of pre-surgical screening and decolonization as adjuncts to SAP.
Main Results:
- Randomized controlled trials for SAP in resistant GNB carriers require very large sample sizes.
- No current professional guidelines specifically address adapting SAP for known carriers of resistant GNB.
- The prevalence of MDR GNB carriage is a key factor in determining the efficiency of different SAP strategies.
Conclusions:
- Surgical antibiotic prophylaxis (SAP) must evolve to combat rising antibiotic resistance and prevent surgical site infections (SSI).
- Strategies for SAP need to consider the prevalence of multidrug-resistant Gram-negative bacteria (MDR GNB) carriage.
- Pre-surgical screening and decolonization may play a role in optimizing SAP in the era of antibiotic resistance.
More Related Videos
09:26Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung
Published on: January 22, 2021
08:19Generating Transposon Insertion Libraries in Gram-Negative Bacteria for High-Throughput Sequencing
Published on: July 7, 2020
Related Concept Videos
00:57Antibiotic Selection
01:30Development of Antibiotic Resistance
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:31Defense Against Bacterial Pathogens
Phagocytes
Phagocytes are the frontline soldiers of the immune system. They include neutrophils and macrophages. Neutrophils are the most abundant type of white blood cell and are quickly mobilized to the site of infection. Macrophages are larger cells that patrol...