Prevention of surgical site infection: need to focus on the enemy within

This review aimed to summarize effective measures to prevent surgical site infections (SSIs) and periprosthetic joint infections (PJIs) following total joint arthroplasty (TJA), focusing specifically on the role of the patient's microbiome in the pathogenesis of SSI and highlighting the importance of targeted decolonization strategies. The impact of the microbiome of the skin, nose, and oral cavity on SSIs is examined. The review includes a detailed analysis of recent literature regarding microbiome-focused interventions and the role of synbiotics in enhancing the gastrointestinal epithelial barrier and reducing pathogen translocation. It also addresses how the host's resistome contributes to antibiotic resistance, which complicates infection prophylaxis. The findings suggest that strategic targeting of the microbiome through specific preoperative, intraoperative, and postoperative protocols can significantly improve surgical outcomes. The evidence supports the efficacy of microbiome-centered approaches in infection prevention, with a substantial focus on the roles of the skin, nasal, and oral microbiomes. However, the potential role of the gut microbiome remains less explored in arthroplasty. Understanding the endogenous sources of SSIs through the microbiome offers a promising direction for reducing infection rates in TJA. While current evidence encourages a shift in pre-operative preparations and post-operative care to incorporate microbiome-centered strategies, further research is necessary to fully explore the potential of the gut microbiome in enhancing prophylaxis against SSIs and PJIs. • Host-related factors contributing to surgical site infections (SSIs) were identified. • These factors are often overlooked in current preventive strategies. • A revised pre-operative protocol targeting host-related factors to reduce SSIs was proposed. • Call for research to establish a clear consensus on the gut microbiome's impact on infection prevention in arthroplasty. • Consensus should underline internal factors as paramount to reducing the incidence of SSIs.