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Stopping antibiotic resistance is the business of every orthopaedic surgeon
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Antibiotics are amazing medications that can effectively attack and kill microorganisms, but unfortunately, the very microorganisms they were developed to target are also highly capable of adapting to the actions of antibiotics. It is well documented that infection-causing bacteria have the ability to develop or acquire mechanisms that provide them with increased resistance to antibiotics. Such resistance to the powerful antibiotics widely used in orthopaedic surgery is of increased concern to orthopaedists today.
Orthopaedic surgeons are worried about this situation because several of the key antibiotics we use regularly are losing their effectiveness against both the most commonly seen simple infections and the multiresistant strains. This has led to an alarming increase in bacterial resistance in orthopaedic surgery at a time when there are practically no new antibiotics in the developmental pipeline. This scenario presents a real threat to our ability to effectively manage infection cases. Without question, this widespread problem will be among the most important public health issues in the future.
Despite this dire situation, prescribing antibiotics is still frequently viewed as a simple, innocuous action. It is a clinical decision rarely discussed either among orthopaedic surgeons or between orthopaedic surgeons and microbiologists. Therefore, it would be wise for orthopaedic surgeons and antibiotic experts to interact and share their insights into antibiotic resistance. Their combined knowledge could prove to be a powerful tool for fighting this growing problem.
Given the magnitude of the threat to patients and quality outcomes posed by antibiotic resistance in orthopaedic surgery, we must be better informed about the situation and how we can be part of the solution, and not the problem. We can start through greater awareness that our actions contribute to antibiotic resistance.
As a next step, the general orthopaedic community should begin an open and ongoing debate about when to prescribe specific antibiotics to treat and prevent infection. This dialogue should focus on how to best combine antibiotics to prevent resistance, cases that can be successfully treated with local rather than systemic antibiotics and when to refer a patient with an infection to a larger unit more skilled in musculoskeletal infection management.
The kinds of discussions and debates I propose must be started now at all orthopaedic centers and within local orthopaedic groups. For them to take root, it is our duty to bring these issues to the attention of high-level policymakers, large patient safety groups, the pharmaceutical industry, international medical and health organizations, and national governments worldwide.
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen has no relevant financial disclosures.