The appropriate use of antibiotics in surgery: A review of surgical infections

Whether it is infections that we are called on to treat or those that we inadvertently cause, surgeons encounter infectious morbidity and mortality on a daily basis. It is estimated that by the year 2030, the US population aged 65 and older will reach 72 million, double that of year 2000.177 As the population ages, the medical community must adapt accordingly. The aging population will require more medical resources and will be at greater risk for the development of nosocomial infection.178 As a result, the balance between medical progress and the subsequent consequences will inevitably continue. We have seen an explosion in the prevalence of MDR pathogens in the last decade. Additionally, we are currently witnessing an epidemic of a new deadly strain of C. difficile that seemingly causes more virulent colitis and is more difficult to treat than ever before. Undoubtedly, both are the consequence of widespread antibiotic abuse. Although clinical and basic science research efforts will continue to advance our treatment of these iatrogenic consequences, as technology evolves, so too will the organisms they are designed to combat. As such, we have a responsibility, not only to our patients, but to the community at large, to practice rational, evidence-based use of antibiotics. Through careful patient selection, antibiotic choices, and shortened durations of therapy, the goal in treatment of surgical infectious disease must be to eradicate infection while preventing the transmission of antimicrobial resistance and iatrogenic disease. © 2007 Mosby, Inc. All rights reserved.