Antibiotic Resistance Threatens Patients Undergoing Immunosuppressive Therapy

The study, by Dr. Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics & Policy in Washington, D.C., and colleagues looked at surgical site infections for hip fracture surgery, pacemaker implantation, spinal surgery, surgical abortion, total hip replacement, cesarean section, transrectal prostate biopsy, appendectomy, colorectal surgery, and abdominal hysterectomy. Cancer chemotherapies included leukemia, lymphoma, and melanoma.

The study determined that the most additional deaths, an estimated 4586 at a 30% reduction in efficacy, would occur in patients undergoing colorectal surgery. A similar reduction in efficacy would result in an additional 683 deaths for patients undergoing blood cancer chemotherapy.

In a statement accompanying the study’s publication, Laxminarayan said, “A lot of common surgical procedures and cancer chemotherapy will be virtually impossible if antibiotic resistance is not tackled urgently.”

The authors acknowledged, however, a number of limitations affecting their study. They wrote that “the definition of reported infections was not uniform across the meta-analyses.” Also, infection control standards may have improved over the decades of meta-analyses they examined, making the results of some studies no longer applicable.

However, they also noted that because “data for mortality rates after each procedure were sparse … we might underestimate the number of additional deaths.”

In conclusion, the authors noted that further study is “needed to establish how antibiotic prophylaxis recommendations should be modified in the context of increasing rates of resistance.”

Reference

1. Teillant A, Gandra S,  Barter D, et al. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modeling study [published online ahead of print October 15, 2015]. Lancet Infect Dis. doi: 10.1016/S1473-3099(15)00270-4.