Surgical site infection (SSI) is one of the most common complications after surgery, occurring in 2-4% of patients undergoing inpatient surgery.Although usually treatable, there is a marked increase in SSI occurring at or near the surgical incision shortly after surgery Likelihood of serious illness even death. No matter how skilled the surgeon, SSI can undermine the success of surgery and adversely affect the health of the patient.as a leading Readmission Contributors, the impact of SSI on healthcare resources also creates a huge financial burden, prompting scientists and healthcare professionals to identify effective preventive measures to reduce SSI rates.
The obvious remedy for avoiding surgical site infections is antibiotics. But it’s not that simple. Standard antimicrobial methods used by surgeons today have limited effectiveness, as evidenced by the prevalence of SSI. These methods provide only brief exposure to antibiotics, which is not always sufficient to eradicate invasive bacteria. Additionally, bacteria can invade surgical wounds during the healing process and without antibiotic coverage long after surgery. Therefore, antimicrobial therapy must be reconfigured for extended long-term use to effectively eradicate any invasive bacteria that may cause SSI.
Rethinking antibiotic stewardship
The standard of care to prevent SSI includes intravenous (IV) antibiotics within one hour before surgery. Prophylactic systemic administration uses large doses of antibiotics to deliver the drug throughout the circulatory system to the surgical site and maintain effective local concentrations. However, most of the drug disperses into unrelated organs, and only a small fraction of the antibiotic dose reaches the wound and is cleared by the kidneys and liver before being excreted in just a few hours.
Another factor to consider is that surgery disrupts the blood supply to the incision site, which further limits the penetration of drugs into the surgical wound. This highly invasive procedure may result in insufficient postoperative antibiotic administration to prevent incisional SSI, as it may take several days after surgery to fully restore blood flow at the incision site. Furthermore, compensating for limited effects by increasing the systemic dose of antibiotics and/or extending the duration of their administration may increase the risk of overall toxicity to patients and may promote the development of antibiotic-resistant strains.
In revealing how antibiotic therapy can be made more effective in preventing SSI, it is reasonable to assume that it is not only the choice of antibiotic but also how it is administered to the wound that determines the effectiveness of treatment. The limited effectiveness of systemic antibiotic administration has led physicians to accept topical therapy—but this has also failed to further reduce the incidence of SSI in high-risk procedures such as abdominal colectomy. To give patients the best chance of being cured and avoiding SSI, while reducing healthcare costs, we must change our approach. We cannot rely solely on poor penetration of the incision site by systemic antibiotics, nor can we mitigate this deficit by exposing patients to toxic and chronically high doses of antibiotics.
There is no doubt that topical antibiotic administration is a core and critical element of any future SSI prevention solution, as it can bypass critical administration issues. However, to be effective, topical administration of antibiotics needs to produce sufficiently high concentration levels locally at the incision and need to avoid SSI throughout and for extended durations. This includes infections caused by hospital-acquired antibiotic-resistant bacteria. To achieve this, topical solutions must store an antibiotic reservoir near the surgical site and release the drug in a controlled manner to deliver durable, high concentrations of antibiotics while maintaining nontoxic systemic exposure.
Currently, localized treatment options leave much to be desired and need to be reformed. Topical antibiotic therapy today comes in many forms, such as antibiotic-infused sheets or high-dose antibiotic powders poured directly into the surgical site. However, these solutions have shown limited or no further reduction in the incidence of SSI, and the effectiveness of SSI prevention over standard solutions has not been demonstrated – especially in high-risk procedures and in the face of challenging antibiotic-resistant bacterial infections.
The key is finding the right topical treatment formulation needed for success. Fortunately, we finally made progress. Such therapies must utilize cutting-edge technology to enable the application of simple topical controlled-release mechanisms that remain anchored to the surgical site, deliver an effective and safe dose of antibiotics, and subsequently degrade at the end of a predetermined release period—all without No external intervention is required. In recent years, sustained-release formulations have been innovated using polymer or lipid technologies, and with some tweaks, they could be the future of topical administration of antibiotics for SSI prophylaxis.
The power of layers… done right
Polymer-based drug delivery systems can capture or mix drugs in a polymer matrix, making them available for anchoring at desired locations, attenuating drug release. However, polymer systems by themselves do not ensure prolonged drug release, as drug release from such polymer-based delivery systems is often uncontrolled, and thus its ability to ensure constant and sufficient drug concentration over a desired period of time is limited by limit. Furthermore, polymers are often unable to protect the embedded drug from degradation over time caused by the body’s natural hydration process, reducing the drug reservoir required for prolonged local action.
Alternatively, lipid-only drug delivery systems, such as liposome-based applications, may better protect the drug’s reservoir from physical harm. However, lipid-only drug delivery systems lack the key properties contained in polymeric systems. Ultimately, neither polymer-based nor lipid-based solutions alone can provide anchored local drug delivery at customizable predetermined rates and prolonged release, key attributes required to improve healing rates.
The power of an effective topical treatment lies in an innovative multi-layer formulation that combines polymer and lipid technologies. These technologies can capture therapeutic drugs, protect drug reservoirs, and slowly dissolve into the body at the desired rate when applied to tissues. With these capabilities, such solutions enable prolonged and efficient drug delivery with minimal systemic exposure over several weeks. By leveraging the quality of each of these treatment delivery systems, patients can be protected during the lengthy recovery process, even weeks after surgery.
The Covid-19 pandemic has been a catalyst for evolutionary change in the healthcare industry, leading to the implementation of innovations previously considered futuristic. SSI prevention is one of the high-profile areas where immediate changes are needed to help reduce patient morbidity and mortality and alleviate the enormous financial burden of hospital care. Physicians may soon find a solution that could be the ideal solution for SSI prevention using a combined, multi-layered system that provides controlled and sustained antibiotic administration to the surgical site. As we identify the best use cases for this multi-layer matrix to ensure its safe and effective use as a drug delivery tool, we can expect transformative healthcare industry support for its implementation, ushering in a revolutionary change in SSI preventive physicians. Been waiting.
Photo: Motortion, Getty Images
