Postoperative infections in the age of drug-resistant gram-positive bacteria

Postoperative infection is a significant cause of surgical morbidity and mortality. The risk of infection after surgery depends on a number of factors, including the type and length of the surgical procedure; the age, underlying conditions, and previous history of the patient; the skill of the surgeon; the diligence with which infection control procedures are applied; and the type and timing of preoperative antibiotic prophylaxis. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, now implicated in many postoperative infections, have been joined most recently by strains of S. aureus that show intermediate levels of resistance to vancomycin. Postoperative infections caused by drug-resistant pathogens are more difficult to treat and are associated with a higher morbidity and mortality. New antibiotics that are effective against drug-resistant pathogens are urgently needed, as is renewed dedication to the prevention of postoperative infection and to the use of the principles of infection control.