Antibiotic Prophylaxis in Gastrointestinal Surgery: Balancing Efficacy and Resistance

Authors:
Amira Elfergani, Main Maitah, Yehya Maitah

Body of Abstract:
Background:
Postoperative infections remain a major concern in GI surgery, contributing to significant morbidity and mortality. Antibiotic prophylaxis is a widely used strategy to reduce the risk of infection. However, the increasing prevalence of antimicrobial resistance calls for rigorous evaluation of current practices and non-antibiotic alternatives, such as probiotics, preoperative optimization, and advanced surgical techniques.

Methods:
A comprehensive review of the literature was conducted using PubMed, focusing on studies published between 2013 and 2023. The search strategy included “antibiotic prophylaxis,” “postoperative infections,” “probiotics,” and “surgical site infections.” Clinical trials, cohort studies, and meta-analyses involving adult patients undergoing GI surgery were included. Data were extracted to evaluate the effectiveness of antibiotic prophylaxis and non-antibiotic strategies in reducing infection rates.

Results:
Antibiotic prophylaxis continues to demonstrate efficacy in reducing surgical site infections (SSIs), particularly when administered within one hour prior to incision. However, extended use or misuse of antibiotics has contributed to rising antimicrobial resistance. Non-antibiotic approaches, including the use of probiotics and synbiotics to modulate the gut microbiome and enhanced recovery protocols, show potential in reducing postoperative infections without contributing to resistance. Surgical Techniques including minimally invasive surgeries, normothermia maintenance, intraoperative antiseptic irrigation, negative pressure would therapy, and antimicrobial-coated sutures and meshes also demonstrated significant reduction in SSIs.

Conclusions:
While antibiotic prophylaxis remains a critical component of infection prevention in GI surgery, it is essential to incorporate non-antibiotic strategies to mitigate resistance risks. Emerging alternatives such as probiotics and surgical optimization provide promising adjuncts to standard care.