Health care providers and patients have long believed that infections acquired in hospitals are due to exposure to superbugs within medical facilities. However, recent genetic data on bacteria causing these infections reveals a different story. Most healthcare-associated infections actually stem from harmless bacteria already present on patients’ bodies before they enter the hospital. A comparison between the microbiome bacteria and those causing various infections like pneumonia, diarrhea, bloodstream infections, and surgical site infections shows that the innocuous bacteria residing on our bodies during health are often responsible for severe infections during sickness.
Surgical site infections, in particular, pose a significant challenge in hospital settings. Research indicates that these infections contribute significantly to the overall costs of hospital-acquired infections, amounting to over 33 percent of the annual expenditure of $9.8 billion. Moreover, they are a leading cause of hospital readmissions and post-surgical mortality. Despite hospitals’ rigorous infection prevention protocols, surgical site infections occur in about 1 out of every 30 procedures without a clear explanation. While many other medical complications have shown improvement over time, the problem of surgical site infections persists and is exacerbated by the global rise of antibiotic resistance.
Research on Surgical Infections
A team of physician-scientists from Harborview Medical Center at the University of Washington delved into the realm of surgical site infections to understand why they occur despite following recommended prevention protocols. Unlike previous studies limited to single bacterial species using older genetic techniques, this team harnessed advanced technologies to study various bacteria and their antibiotic resistance genes simultaneously. Their focus on infections following spinal surgery was prompted by the equal distribution of spine surgeries among men and women, substantial healthcare resources allocated to spinal procedures, and the devastating effects of post-surgery infections on patients.
Over a one-year period, the team sampled bacteria from the nose, skin, and stool of over 200 patients before spinal surgery and followed their progress for 90 days. The results unveiled distinct patterns in bacterial colonization on different body regions, with a remarkable similarity between the bacteria in specific skin areas and those causing post-surgery infections in corresponding spinal regions. Surprisingly, 86 percent of infection-causing bacteria after spine surgery were genetically identical to the bacteria carried by patients pre-surgery, with nearly 60 percent being resistant to preventive antibiotics used during surgery or skin antiseptics.
The discovery that surgical infections primarily originate from patients’ microbiomes opens up avenues for personalized infection prevention strategies. Instead of the current one-size-fits-all approach, tailored antimicrobial regimens based on individual microbiome data could enhance the effectiveness of infection prevention protocols. By utilizing information on patients’ microbiomes, clinicians could identify targeted antimicrobials, thereby reducing the risk of post-surgical infections caused by antibiotic-resistant bacteria acquired outside the hospital setting.
While current infection prevention practices emphasize the sterility of the hospital environment, it is evident that the majority of infections stem from patients’ own microbiomes. This realization underscores the importance of transitioning towards patient-centered, personalized approaches to infection prevention. By understanding and addressing the microbial sources of infections proactively, hospitals and patients can benefit from reduced infection rates and improved outcomes, paving the way for a paradigm shift in healthcare practices.
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