Antibiotics and Surgery

[James Marusek 5,244]

When we are in the hospital for surgery, generally we can be administered antibiotics to prevent wound infection. This is not a bad thing. There are a lot of bad bacterial germs floating around in a hospital setting.

Most surgical procedures do not require prophylactic or postoperative antibiotics. However, certain patient-related and procedure-related factors alter the risk/benefit ratio in favor of prophylactic use.

Patient-related risk factors suggesting need for antibiotics include

• Certain valvular heart disorders

• Immunosuppression

Procedures with higher risk involve areas where bacterial seeding is likely:

• Mouth

• GI tract

• Respiratory tract

• GU tract

In so-called clean (likely to be sterile) procedures, prophylaxis generally is beneficial only when prosthetic material or devices are being inserted or when the consequence of infection is known to be serious (eg, mediastinitis after coronary artery bypass grafting).

Choice of antibiotics is based on the Surgical Care Improvement Project (SCIP) guidelines (see Perioperative Management). There is strong evidence that standardizing antibiotic choices and adhering to SCIP protocols or another standardized and validated protocol reduce the risk of surgical infection. Some regions of the US that followed SCIP guidelines were able to decrease surgical site infections by 25% from 2006 to 2010. Drug choice is based on the drug's activity against the bacteria most likely to contaminate the wound during the specific procedure (see Table: Antibiotic Regimens for Certain Surgical Procedures). The antibiotic is given within 1 h before the surgical incision (2 h for vancomycin and fluoroquinolones). Antibiotics may be given orally or IV, depending on the procedure. For most cephalosporins, another dose is given if the procedure lasts > 4 h. For clean procedures, no additional doses are needed, but, for other cases, it is unclear whether additional doses are beneficial. Antibiotics are continued > 24 h postoperatively only when an active infection is detected during surgery; antibiotics are then considered treatment, not prophylaxis.

The Center for Disease Control has published guidelines for prevention of surgical site infections that address topical and nondrug antiseptic measures (eg, bathing, sealants, irrigation, prophylaxis for prosthetic devices).

Source: Prevention of Surgical Infections

The antibiotics destroy not only the bad bacteria in the gut but also the good bacteria. Therefore I feel it is important to reestablish the good gut bacteria after surgery by using Probiotics. I ran across an article this morning that discusses the relationship of gut bacteria and weight gain.

While it has long been known that low dose antibiotics cause weight gain in animals, the mechanism by which they do this has been a mystery. Researchers are now beginning to zero in on the effect and their work may even shed light on the human obesity epidemic. Animals, like humans, have numerous bacterial species living in their gut. Believe it or not, there are more bacterial cells in our body than human cells. Of course, bacterial cells are much smaller than human cells. But their effect on our health may not be small.

Some varieties of bacteria are more likely to cause the body’s immune system to swing into action, but usually different bacteria keep each other’s multiplication rate in check by competing for the same food supply. But if the bacterial balance is upset because an antibiotic reduces the numbers of one species more than others, an inflammatory response can occur. Such a response is linked with making our cells less sensitive to insulin. “Insulin resistance” means that glucose is less likely to be taken up by cells, and since it is the cell’s main source of energy, they crave an increased intake. This translates to a boost in appetite as the body strives to meet cellular needs.

What all of this suggests is that some species of bugs in our intestine may contribute to weight gain more than others, and that these may become more prevalent when competitors are reduced by antibiotics. Of course, other factors may also play a role in altering the bacterial flora. The chlorination of drinking Water as well as improved sanitation may influence both the type and the number of microbes that reside in our gut. Who knows, perhaps all that emphasis on getting rid of germs may be affecting our waistline.

Is there any actual evidence for this postulated link between changes in gut bacteria and obesity? In one word, yes. When Martin Blaser, a microbiologist at New York university, fed infant mice doses of penicillin comparable to those given farm animals, he found that after 30 weeks these mice had put on 10-15% more weight than those not treated with the antibiotic. Furthermore, the mice that had been treated had a different microbial flora in their gut, with Lactobacillus, one of the “good” bacteria, having significantly decreased. When gut bacteria from these mice were introduced into mice had been bred in a totally sterile environment, and were therefore germ-free, they put on more weight than mice with the regular complement of microbes in their gut.

While overconsumption of food is the crux of the obesity problem, one of the reasons why we eat too much, as we have now seen, may be due to the changes that have occurred in the microbial population of our gut. A study of ancient feces from caves, as well as from the intestinal tract of mummies, has revealed a microbial makeup that is quite different from that found in our guts today. Those ancient microbial populations are more similar to the ones found in chimps, gorillas and children in rural Africa than in the intestines of North Americans who are more likely to have been exposed to chlorinated water, antimicrobial cleaning agents and antibiotics. Maybe a partial answer to obesity is to repopulate our intestines with the bacteria found in ancient poop.

Source: Bugs In Our Guts

[GreenTealael 24,964]

Thanks!!! And for citing your sources also 👌

Edited January 7, 2019 by GreenTealael