Some of the most common clinical conditions that surgeons manage, are infectious in nature. Additionally, healthcare-associated infections, such as surgical site infections, urinary tract infections, and hospital-acquired pneumonia, are among the most common complications surgeons face in their clinical practice.
Compliance with infection prevention and control measures and appropriate infection management practices should be integral to good clinical practice and standards of care. However both infection prevention and control measures and appropriate infection management among surgeons are often inadequate.
Antimicrobial resistance (AMR) has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health and food security. Although the phenomenon of AMR can be attributed to many factors and a “one health” approach is needed, there is a well-established relationship between antibiotic prescribing practices and the emergence of AMR.
In 2017 the Global Alliance for Infections in Surgery shared with over 230 experts from 83 different countries a global declaration on appropriate use of antimicrobial agents in hospitals worldwide. Within this declaration, the authors highlighted the contribution of antibiotic exposure, misuse, and overuse to antibiotic resistance and outlined the fundamental principles of appropriate antibiotic prophylaxis and therapy in surgery.
Not specifically highlighted in their declaration but of significant importance in limiting antibiotic exposure are efforts to prevent hospital-acquired infections. Prevention of hospital-acquired infections can limit significantly the need for antibiotic therapy
Although most surgeons are aware of the problem of AMR, most underestimate this problem in their own hospital worldwide and inappropriate use of antibiotics and other antimicrobials, as well as poor prevention and control of infections, are contributing to the development of antimicrobial resistance.
A growing body of evidence demonstrates that hospital based programs dedicated to improving antibiotic use, commonly referred to as “Antibiotic Stewardship Programs” (ASPs), can both optimize the treatment of infections and reduce adverse events associated with antibiotic use.
We propose that the best means of improving ASPs worldwide should involve collaboration among various specialties within a healthcare institution including prescribing clinicians.
Efforts to improve educational programs are required and it is necessary that ASPs develop appropriate educational programs to steer prescribers towards judicious behaviour in prescribing antibiotic
It is crucial that surgeons have awareness of the problem of AMR and that understand that using antibiotics inappropriately may increase the likelihood of treatment failures and antimicrobial resistance.
Surgeons should always be aware that making judicious antibiotic prescriptions is an integral part of the behavior of all healthcare professionals and that an appropriate antimicrobial therapy may maximise clinical cure and minimise emergence of antimicrobial resistance. If surgeons around the world will be able to participate in the global fight against AMR and demonstrate awareness of the major problem of antimicrobial resistance, they will become pivotal in this fight. If surgeons will not demonstrate to use antibiotics judiciously, repressive measures will be needed depriving them the opportunity to treat their patients.
Surgeons; hear your call. It is your time to participate and your time to lead. Now is the time to act!