Greater Global Co-ordination is Needed to Address SSI Prevention and Antibiotic Resistance

SSISurgical Site Infections (SSI) are a significant risk factor for patients undergoing surgeries. In fact, 77% of deaths among patients with SSI are directly attributable to SSI. Patients with an SSI have a 2-11 times higher risk of death, compared with operative patients without an SSI. Each SSI is associated with approximately 7-10 additional postoperative hospital days, resulting in significant financial burdens to the healthcare system.  SSIs are classified as superficial incisional (involving only skin or subcutaneous tissue of the incision), deep incisional (involving fascia and/or muscular layers) and organ/space. 1 The cost of each SSIs ranges from $1,000 to $100,000. SSIs are believed to account for up to $10 billion annually in healthcare expenditures in the US, and up to $1billion in Canada…before including the cost impact on families and the economy.

Significant reductions in SSI rates have been realized due to adoption of protocols involving prophylactic use of potent systemic antibiotics like Vancomycin. Long term Vancomycin resistance generation resulting from more widespread use is the trade-off for these significant reductions in short term SSI rates. Vancomycin, long considered one of the potent “last resort” class of antibiotics, has become a prophylactic medical tool to keep surgical site infections in check. The challenge is that there are too few new classes of last resort antibiotics being developed to replace Vancomycin should significant resistance evolve, due to the $1-1.5 billion cost and over a decade required for new drug development.

In light of this challenge, there should be a global coordinated effort to develop new classes of powerful replacement antibiotics as well as a global coordination of antibiotic rotation to preserves the ones that we do have. More emphasis should be taken on screening for at-risk individuals as well as health care workers, at times, the vectors of the spread of infection. Non-antibiotic antimicrobial therapies, such as Photodisinfection, Ultra-Violet Robotic Sterilization, etc. should be quickly advanced and integrated into healthcare associated infection prevention protocols. The superior patient outcomes would be well received around the world and the economics easily justified.

Reference: Infection Control Hospital Epidemiology/Volume 29/Supplement S1/ October 2008, pp S51-S61

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