Routine surgery and chemotherapy may become all but impossible unless urgent action is taken to halt the waning efficacy of antibiotic drugs, according to research.



A paper says rising resistance to antibiotics routinely used to prevent patients getting infections during and after surgery is a disaster. It will mean increased risk for operations such as caesareans, hip replacements and appendix removal, and also treatment for cancer patients, who are given antibiotics because chemotherapy drugs undermine their immune system, making them vulnerable to infections.

Antimicrobial resistance is recognised as a looming threat to health, but usually because the drugs are losing their power to fight and cure serious infections, from tuberculosis to gonorrhoea and hospital-acquired superbugs.



But antibiotics are also used to prevent infections. A study in the journal Lancet Infectious Diseases has, for the first time, quantified the potential impact of resistance in the operating theatre and in chemotherapy. If the drugs lose just 30% of their efficacy, it says, there could be 120,000 more infections and 6,300 infection-related deaths each year in the US alone.

The US-based team, led by Dr Ramanan Laxminarayan, director of the Centre for Disease Dynamics, Economics and Policy, in Washington, found that 39% of surgical site infections after caesareans and 50-90% in infections following the commonest sort of prostate cancer biopsy are caused by organisms that are resistant to the antibiotic drugs normally given to the patient before the procedure.

Just over a quarter of infections (27%) following blood cancer chemotherapy are resistant to standard antibiotics, they found.

“A lot of common surgical procedures and cancer chemotherapy will be virtually impossible if antibiotic resistance is not tackled urgently,” said Laxminarayan. He said more information was urgently needed so that recommendations on which drugs to give patients could be modified, “but we also need new strategies for the prevention and control of antibiotic resistance at national and international levels”.

In a linked comment piece in the journal, Joshua Wolf from St Jude children’s research hospital, Memphis, said the study’s authors “describe a future in which patients who need surgery or chemotherapy can no longer be protected from life-threatening infections by antibiotic prophylaxis.

“All clinicians have a responsibility to prevent this situation from becoming our patients’ reality by supporting efforts to combat antimicrobial resistance worldwide and by supporting antimicrobial stewardship at home.”

Prof Nigel Brown, president of the Microbiology Society, said the study was robust. “Although this analysis was carried out in the US, antibiotic resistance is a global problem and it is likely that routine surgery such as hip replacement and elective caesarean sections will become much rarer in the UK unless steps are taken to prevent its spread,” he said.

Prof Laura Piddock, director of Antibiotic Action and professor of microbiology at the University of Birmingham, said the evidence supported the serious concerns that antibiotic resistance would undermine many areas of medicine, including cancer treatment.

“I hope that this will be a loud wake-up call to pharmaceutical companies and encourage them to discover, research and develop new treatments for bacterial infections, as without them patients will be less likely to survive cancer and so unable to take advantage of new life-extending cancer therapies,” she said.

Prof David Livermore, professor in medical microbiology at the University of East Anglia, said: “There are legitimate concerns about prophylaxis failure in a small number of settings, including prostate biopsy and in leukaemia patients.”

But he said there was as yet no substantial evidence that giving antibiotics before surgery in the UK was failing to prevent infection. “At present infection rates are generally falling slightly in the UK,” he said.