In September, the White House moved to take on the scourge of antibiotic-resistant bacteria through an extensive, multi-pronged battle plan. Now, one physician says by changing how antibiotics are administered, physicians could possibly reduce the rates of infection after surgery nearly tenfold, lessening the amount of antibiotics necessary throughout the world.
The use of fewer antibiotics would mean having fewer antibiotic-resistant strains of bacteria, says Fred Sweet, MD, co-founder of Rockford (Ill.) Spine Center.
Dr. Sweet says the new technique has surgeons place antibiotic powder — namely, vancomycin — on a patient's surgical wound, instead of through a pre-operation IV.
In a study, recently conducted and presented to the Scoliosis Research Society, he tested his theory on rats.
"I took some rats and gave them some IV antibiotics and then I took some rats and put some vascular mesh in their wounds and put some vancomycin powder on the mesh," says Dr. Sweet.
The physician said he gave these rats a good deal of bacteria to ensure the chances of getting them infected were very high.
"As it turns out, for the rats that got the IV, 100 percent became infected. For the vancomycin powder? None of them," he says.
Part of the vancomycin powder's success is dependent upon the fact that the antibiotic's molecule is very large and, as such, isn't easily absorbed into the body.
Other powder-form antibiotics were used in Dr. Sweet's study — tobramycin and cefazolin, to name two. The success rates for the smaller-molecule antibiotics were significantly less impressive: a 30 percent infection rate for the tobramycin and a 70 percent infection rate for cefazolin.
Dr. Sweet attributes another aspect of vancomycin's success to the fact that applying the powder directly to the wound significantly increases the on-site concentration of the antibiotic, compared to the dilution that occurs through an IV.
"The amount we put on the wound is equivalent to what's given in an IV," says Dr. Sweet. "However, it's a much smaller space, so the concentration is 10 to 100 times higher than it is in the IV. It's just a much more effective dose."
Current standard protocols mandate that physicians give patients antibiotics intravenously at least an hour before surgery, Dr. Sweet says, and that's what he's hoping to change.
"When you give antibiotics by mouth or IV, it goes through your entire body. Everywhere in the body sees it and all the bacteria that's already in your body sees it. If you put it in the wound — it's not well absorbed — it stays in that part of the body. That's probably the difference, theoretically."
This particular technique works for surgeries where Staph infections are the risk, Dr. Sweet says, estimating that accounts for about 85 percent of all surgeries nationwide.
"But for other surgeries that Staph isn't the issue, we need to be looking and asking 'Are there other antibiotics and other delivery methods we can use with this technique?'"
There are plenty of hurdles for Dr. Sweet and the technique he's been supporting, still.
He estimated that it'll be 15 to 20 years before the technique could become the status quo, but added that, from what he could tell, "If we can reduce these systemic antibiotics, I think within just a few years after that the number of resistant organisms will fall off the charts."