The evolving threat of antimicrobial resistance in surgical site infections: Mechanisms, epidemiology, and innovative mitigation strategies

The relentless rise of antimicrobial resistance (AMR) in surgical site infections (SSIs) threatens the foundation of modern surgery, escalating patient morbidity, mortality, and healthcare costs while challenging the efficacy of conventional antibiotic therapies. This review delves into the intricate mechanisms driving AMR, including genetic mutations, biofilm formation, and efflux pumps, which empower pathogens like methicillin-resistant Staphylococcus aureus and multidrug-resistant Gram-negative bacteria to evade treatment. It unveils the alarming global epidemiology of resistant SSIs, with low- and middle-income countries disproportionately burdened due to limited diagnostic and infection control resources. The paper confronts the formidable challenges of delayed diagnostics, dwindling antibiotic efficacy, and inconsistent stewardship, while spotlighting innovative mitigation strategies that redefine SSI management. Tailored antimicrobial prophylaxis, non-antibiotic approaches like bacteriophage therapy and nanotechnology, advanced infection prevention techniques, and novel pharmacological agents offer hope in combating resistance. By weaving together the expertise of surgeons, medical professionals, and pharmacists, bolstered by robust policy and education, this review charts a path toward sustainable solutions. It calls for global collaboration to curb the AMR crisis, ensuring that surgical interventions remain safe and effective for future generations.