Health care providers and patients have traditionally believed that infections acquired in hospitals are caused by exposure to superbugs within medical facilities. However, recent genetic data has revealed a different narrative. Research indicates that most health care-associated infections stem from previously harmless bacteria that patients already harbor on their bodies before entering the hospital. These bacteria, found in the microbiome, can become the culprits behind serious infections such as pneumonia, diarrhea, bloodstream infections, and surgical site infections.
Among the various types of health care-associated infections, surgical site infections present a significant challenge. Studies have shown that surgical site infections contribute extensively to the costs associated with hospital-acquired infections, making up over 33 percent of the annual total expenditure. These infections also increase the risk of hospital readmission and mortality post-surgery, posing a substantial threat to patients undergoing surgical procedures. Despite stringent infection control measures, surgical site infections continue to occur following approximately 1 in 30 surgeries, with no clear explanation for their occurrence.
Data from the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention indicate that the issue of surgical site infections is not showing signs of improvement. Moreover, the global rise in antibiotic resistance poses a further challenge to infection prevention efforts. Antibiotic administration during surgery is a key preventive measure, but the increasing prevalence of antibiotic-resistant bacteria is forecasted to elevate infection rates following surgical procedures.
As a team of physician-scientists, our focus was on understanding the underlying factors contributing to surgical infections despite adherence to established preventive protocols. Previous research on surgical site infections has been limited in scope and methodology. However, advancements in genetic analysis technologies now allow for comprehensive studies on various bacteria and their antibiotic resistance genes simultaneously. To delve deeper into this issue, we concentrated on infections related to spinal surgery due to the procedure’s prevalence and complexity.
Over the course of our study, we examined the bacteria present in the microbiome of over 200 patients before spinal surgery and monitored them for infections post-operation. Our findings highlighted distinct patterns of bacteria colonization on different regions of the skin, particularly on the back. Surprisingly, a significant proportion of the bacteria causing infections after surgery were a genetic match to those carried by patients prior to the procedure. Furthermore, a substantial number of these infections demonstrated resistance to antibiotics administered during surgery or used for skin preparation before the incision.
The revelation that surgical infections originate from the patient’s microbiome presents a unique opportunity for personalized infection prevention strategies. Current protocols rely on generic approaches such as standard antibiotics for all patients, irrespective of their individual microbial composition. Moving towards personalized infection prevention could enhance the efficacy of these measures by tailoring them to the specific microbiome of each patient.
While our findings offer valuable insights into the origins of surgical site infections, further research is essential to optimize the interpretation of microbiome data and assess the implications of personalized infection prevention strategies. Shifting the focus of infection prevention towards individualized approaches could lead to improved outcomes for both patients and healthcare facilities. By leveraging information about the patient’s microbiome, medical teams can develop targeted antimicrobial strategies, paving the way for a new era of infection prevention in healthcare settings.
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