Antibiotics and Metabolic Dysregulation After Surgery: Exploring an Overlooked Connection

Hypertension and hyperglycemia are common in patients without metabolic disease even after surgery and are generally considered to have been caused by surgical stress and inflammation. Nonetheless, in the case of long-term or repeated exposure to perioperative antibiotics, this can be a hidden cause of disturbances. Broad-spectrum antibiotics may interfere with gut microbiota, decrease short-chain fatty acid synthesis, and impair mitochondrial function and vascularity, thereby facilitating the development of insulin resistance and metabolic instability. Observational cohort evidence associates cumulative exposure to antibiotics with the risk of developing type 2 diabetes, whereas experimental models show that antibiotics cause glucose intolerance via the mechanism of dysbiosis. There are also clinical observations that, in certain patients, suitable parameters of the metabolic condition return to normal only on removal of antibiotics. These mechanisms can interact with surgical stress, especially in metabolically vulnerable individuals. This hypothesis-generating editorial demonstrates the need to explore antibiotic-related metabolic changes during postoperative care and to implement microbiome-informed interventions in perioperative practice and antibiotic stewardship.