Though it has been traditionally thought that microbial exposure in the hospital could be the reason individuals may get infected, a new study supports the notion that bacteria that are innocuous and live in the body when healthy could be the culprit behind surgical infections when people are sick.
Surgical Site Infections
Among various infections associated with healthcare, infections of the surgical site appear to be quite problematic. According to a 2013 study, surgical site infections account for most of the annual costs of infections acquired in the hospital. They are also a major reason for post-surgery readmission and death.
As part of the new study, the researchers saw the great lengths hospitals have taken to prevent such infections. These efforts include sterilizing surgical equipment, using UV light for OR cleaning, monitoring airflow in the OR, and adhering to strict surgical attire protocol.
Nevertheless, surgical site infections still appear in roughly one out of 30 procedures. These usually do not have any explanation. Though the rates of several medical complications have been showing steady improvement as time passes, data from the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality reveal that the matter has not improved.
Bacteria Already Present Could Be Responsible
As part of the new study entitled "Contribution of the Patient Microbiome to Surgical Site Infection and Antibiotic Prophylaxis Failure in Spine Surgery," a team of scientists and physicians with various specializations collaborated. The scope of these experts covers infectious disease, critical care, lab medicine, pharmacy, neurosurgery, and orthopedics. The scientists wanted to understand why and how surgical infections surfaced among patients even if recommended protocols for prevention were followed.
Early surgical site infection studies have focused only on a single bacteria species and used older methods for genetic analysis. However, new technologies have opened the door to investigating all bacteria types and simultaneously examining their antibiotic-resistance genes.
The researchers specifically focused on spinal surgery infections. This is due to how a similar number of men and women go through this type of surgery for different reasons across their lifespan, making their findings more applicable to an enormous scope. They also chose this because more healthcare resources are expended on spinal surgery compared to other surgical procedures across the US. Moreover, spinal surgery infections could be pretty devastating for patients due to how it may typically necessitate long antibiotic courses and even repeat surgeries.
Over the course of one year, the researchers sampled bacteria that live in the stool, skin, and nose of more than 200 patients before surgery. They then followed the group for 90 days to compare these samples with post-surgery infections.
Findings revealed that though the bacteria species that live on patients' back skin may widely vary across people, there are clear patterns. Bacteria that colonize the upper back surrounding the shoulders and neck are similar to those found in the nose. In contrast, the bacteria in the lower back exhibit higher similarity with those in the stool and gut. Their presence in such regions of the skin closely mirrors their frequency of showing up in post-surgery infections on those specific spinal regions.
Interestingly, 86% of the bacteria that lead to spinal surgery infections genetically match the bacteria that a patient carried prior to the surgery.
Almost 60% of the infections were also resistant to the preventive antibiotic administered during surgery. It appears that the antibiotic resistance source was not due to hospital exposure but to the microbes that the patient already unknowingly had. The antibiotic-resistant microbes could have been acquired through prior exposure, routine community contact, or consumer products.
While the results may appear intuitive, they may yield substantial implications for care and prevention. If the most likely surgical infection source is known beforehand, medical teams may be able to protect it before surgery. As present protocols adhere to a one-size-fits-all approach, personalization could see more significant effects.
Clinicals may use microbiome data in the future to choose more targeted antimicrobials. However, further research is necessary to understand how to interpret the data and the approach that would yield better outcomes.
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