New Delhi: The rising threat of antimicrobial resistance (AMR) is making routine surgical procedures increasingly challenging, with surgeons warning that the declining effectiveness of antibiotics could reverse decades of progress in preventing post-operative infections.

Medical experts say antibiotics remain an essential part of modern surgery, but their unnecessary and prolonged use has contributed to the emergence of drug-resistant bacteria. As a result, hospitals are placing greater emphasis on antibiotic stewardship, infection prevention and evidence-based prescribing practices to protect patients and preserve the effectiveness of existing medicines.

Effective antibiotics are vital for surgery

According to surgeons, the success of many surgical procedures depends not only on surgical expertise but also on the availability of effective antibiotics to prevent and treat infections.

Dr Amarchand Bajaj, Senior Consultant for General Surgery at the Sitaram Bhartia Institute of Science and Research, said procedures ranging from appendectomies and gall bladder operations to major gastrointestinal surgeries rely on antibiotics to reduce the risk of post-operative complications.

He warned that infections caused by antibiotic-resistant bacteria can lead to longer hospital stays, delayed recovery and an increased risk of serious complications.

WHO recommends limited antibiotic use

The World Health Organization (WHO) recommends that antibiotics used to prevent surgical site infections should generally be administered before the surgical incision and should not routinely be continued after surgery in most cases.

Medical experts say prolonged antibiotic use after surgery offers little additional benefit for most clean surgical procedures while increasing the risk of antimicrobial resistance.

Dr Bajaj said the misconception that “more antibiotics provide better protection” continues to persist among some patients and healthcare settings.

He stressed that the goal is to administer the right antibiotic at the correct time and discontinue it when no longer required, as unnecessary antibiotic exposure contributes to resistance and may also increase the risk of side effects.

Drug-resistant bacteria remain a concern

Surgeons say hospitals are increasingly encountering multidrug-resistant bacteria responsible for post-operative infections.

Among the organisms of concern are:

  • Klebsiella pneumoniae
  • Acinetobacter baumannii
  • Methicillin-resistant Staphylococcus aureus (MRSA)

The growing prevalence of these resistant organisms has made infection prevention strategies more important than ever.

Infection prevention extends beyond antibiotics

Medical experts emphasise that preventing surgical site infections requires a comprehensive approach rather than relying solely on antibiotics.

Dr Asuri Krishna, Professor in the Department of Surgery at AIIMS Delhi, said measures such as controlling diabetes before surgery, encouraging smoking cessation, maintaining strict operating theatre sterility, proper skin preparation, timely administration of antibiotics and early mobilisation after surgery all play a crucial role in reducing infection risk.

He noted that antibiotics cannot compensate for lapses in infection-control practices.

AMR is a major global health threat

Antimicrobial resistance has emerged as one of the world’s leading public health concerns.

A widely cited analysis published in The Lancet estimated that 1.27 million deaths were directly attributable to bacterial antimicrobial resistance in 2019, while 4.95 million deaths were associated with drug-resistant bacterial infections.

Experts warn that if antibiotic resistance continues to rise, it could significantly affect the safety of surgeries, organ transplants, cancer treatment and other medical procedures that depend on effective infection control.

Hospitals adopting antibiotic stewardship

Dr V K Bansal, Professor in the Department of Surgery at AIIMS Delhi, said antimicrobial stewardship programmes have become an important component of hospital practice.

These programmes promote:

  • Appropriate antibiotic selection
  • Correct timing of administration
  • Microbiological surveillance
  • Monitoring of prescribing patterns
  • Judicious use of antibiotics

The objective is to minimise unnecessary antibiotic exposure while maintaining patient safety and reducing the emergence of resistant bacteria.

Doctors also called for greater public awareness, noting that many patients still expect antibiotics to continue for several days after surgery despite international guidelines advising otherwise for most routine procedures.

India tracks surgical site infections

India has also strengthened surveillance of surgical site infections through a multicentric programme led by the Indian Council of Medical Research (ICMR).

The study, conducted across hospitals nationwide, reported an overall surgical site infection (SSI) incidence of 5.2 per cent.

Researchers identified prolonged surgeries, contaminated wounds, higher anaesthesia risk scores and complex procedures such as debridement and laparotomy as major risk factors for infection.

The surveillance programme is expected to help hospitals improve infection-control practices and develop targeted strategies to reduce post-operative infections.

Preserving antibiotics for the future

Health experts say combating antimicrobial resistance requires coordinated efforts from doctors, hospitals, policymakers and patients alike.

They emphasise that responsible antibiotic use, adherence to evidence-based treatment guidelines and strong infection-prevention practices are essential to ensure antibiotics remain effective for future generations and continue to support safe surgical care.