Antibiotics alone cannot compensate for poor infection-control practices
For a century, the surgeon's knife and the antibiotic have worked in partnership, making the extraordinary ordinary — turning life-threatening conditions into manageable procedures. Now, across India and around the world, that partnership is fraying. The indiscriminate use of antibiotics has cultivated bacteria that no longer yield to the drugs designed to kill them, and surgeons are warning that without a collective reckoning, the routine operations of modern medicine may cease to be routine at all.
- Bacteria resistant to multiple drugs are appearing in post-operative wounds, turning recoveries into crises and leaving surgeons without reliable tools to fight infection.
- A deeply rooted misconception — that more antibiotics mean safer surgery — continues to drive overuse in hospitals and among patients, accelerating the very resistance it seeks to prevent.
- WHO data and an ICMR national study have given India a measurable baseline: surgical site infections strike 5.2% of patients domestically and up to 11% in low-income countries globally, with prolonged antibiotic use offering no added protection.
- Hospitals are building antimicrobial stewardship programs to enforce correct timing, dosage, and discontinuation of antibiotics — but experts insist stewardship alone cannot substitute for sterile theatres, pre-surgical diabetes control, and disciplined infection prevention.
- The human cost is already catastrophic — 1.27 million deaths directly caused by antimicrobial resistance in 2019 alone — and surgeons are calling on every doctor, hospital, and patient to treat antibiotic preservation as a shared moral obligation.
A patient survives an appendectomy, wakes from anesthesia, and then, days later, develops a fever. The infection that follows does not respond to antibiotics. This is no longer a hypothetical — it is a pattern that surgeons across India are watching emerge with alarm.
Dr. Amarchand Bajaj of the Sitaram Bhartia Institute frames the crisis plainly: modern surgery depends on antibiotics as surely as it depends on the surgeon's skill. Appendectomies, gallbladder removals, major gastrointestinal procedures — all can spiral into life-threatening complications when the bacteria colonizing a surgical wound cannot be killed. The problem is not antibiotic use itself, but the way antibiotics are being used.
WHO guidelines are unambiguous: prophylactic antibiotics should be administered before the incision and, in most cases, stopped when surgery ends. Prolonged use beyond that window provides almost no additional protection — it only cultivates resistance. Yet the belief that more antibiotics equal safer surgery persists among patients, and even within some hospitals. Bajaj is direct in his rejection of that logic: every unnecessary dose feeds resistance and exposes patients to harm they did not need to suffer.
The pathogens now appearing in post-operative infections — Klebsiella pneumoniae, Acinetobacter baumannii, MRSA — are organisms that have learned to survive the drugs once capable of destroying them. The global toll is immense: a Lancet analysis found antimicrobial resistance directly caused 1.27 million deaths in 2019, with nearly five million more deaths associated with drug-resistant infections that year.
Hospitals are responding with antimicrobial stewardship programs — structured systems for selecting the right antibiotic, timing it precisely, and monitoring prescribing patterns. But Dr. Asuri Krishna of AIIMS Delhi cautions that stewardship is only one piece of a larger puzzle. Controlling blood sugar before surgery, encouraging patients to stop smoking, maintaining rigorous theatre sterility, preparing the skin correctly, getting patients moving early after procedures — all of these matter. Antibiotics, he warns, cannot compensate for weak infection-control practices.
An ICMR-led national surveillance study found a surgical site infection rate of 5.2% across Indian hospitals, identifying longer surgeries, contaminated wounds, and complex procedures as key risk factors. That data gives the medical community both a measure of the problem and a mandate to act. As Dr. V K Bansal of AIIMS Delhi puts it, preserving the antibiotics that remain effective is a responsibility shared by every surgeon, every institution, and every patient — because the window to act, before routine surgery becomes routinely dangerous, is narrowing.
A surgeon's hands move with practiced precision through an appendectomy. The incision closes. The patient wakes. And then, days later, fever. Infection. But the bacteria won't die. The antibiotics that once would have saved this patient's life no longer work.
This scenario is no longer theoretical. Surgeons across India are sounding an alarm: the casual overuse of antibiotics—the assumption that more doses mean better protection, that treatment should stretch days beyond surgery—has created a crisis that threatens to undo a century of surgical progress. What was once routine is becoming dangerous.
Dr. Amarchand Bajaj, a senior consultant in general surgery at the Sitaram Bhartia Institute of Science and Research, puts it plainly: modern surgery depends on antibiotics as much as it depends on surgical skill. An appendectomy, a gall bladder removal, a major gastrointestinal procedure—any of these can spiral into life-threatening complications if the bacteria that inevitably colonize a surgical wound cannot be killed. The problem is not that we use antibiotics. The problem is how we use them.
The World Health Organization reports that surgical site infections are the most common healthcare-associated infections in low and middle-income countries, striking up to 11 percent of patients who undergo surgery. Yet the WHO's own guidelines are clear: antibiotics for surgical prevention should be given before the incision is made, and in most cases should not continue after surgery ends. Prolonged use offers almost no additional benefit. It only breeds resistance.
Yet the misconception persists—among patients, among some hospitals, even among some doctors—that more antibiotics equal safer surgery. Bajaj rejects this logic entirely. "The objective is not to give antibiotics for several days after surgery but to administer the correct antibiotic at the right time and discontinue it when evidence suggests," he said. Every unnecessary dose is a small act of harm: it feeds resistance and exposes patients to side effects they did not need to endure.
The bacteria themselves are becoming the enemy. Hospitals now regularly encounter multidrug-resistant organisms—Klebsiella pneumoniae, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus—in post-operative infections. These pathogens laugh at the antibiotics that once would have destroyed them. Globally, the toll is staggering. A major analysis published in The Lancet found that bacterial antimicrobial resistance directly caused 1.27 million deaths in 2019, with another 4.95 million deaths associated with drug-resistant bacterial infections. Antimicrobial resistance is now one of the world's leading public health threats.
Hospitals are responding by building antimicrobial stewardship programs—systematic approaches to choosing the right antibiotic, timing it correctly, monitoring what is actually prescribed, and tracking outcomes. But stewardship alone is not enough. Dr. Asuri Krishna, a professor of surgery at AIIMS Delhi, emphasizes that infection prevention requires a comprehensive strategy that extends far beyond pills. Optimizing a patient's diabetes before surgery matters. Encouraging smoking cessation matters. Maintaining strict operating theatre sterility matters. Proper skin preparation matters. Early mobilization after surgery matters. "Antibiotics alone cannot compensate for poor infection-control practices," Krishna said.
India has begun measuring the problem systematically. An ICMR-led multicentric surveillance study across hospitals nationwide found a surgical site infection rate of 5.2 percent. The study identified longer surgery duration, contaminated wounds, higher anesthesia risk scores, and complex procedures like debridement and laparotomy as major risk factors. This data gives hospitals a baseline—and a mandate to strengthen their defenses. Dr. V K Bansal, another professor of surgery at AIIMS Delhi, frames the challenge as a collective responsibility: "As bacteria become increasingly resistant, preserving the effectiveness of existing antibiotics is everyone's responsibility. Every surgeon, every hospital and every patient has a role in ensuring these life-saving drugs remain effective for future generations." The question now is whether that responsibility will be taken seriously before routine surgery becomes routinely dangerous.
Citas Notables
Modern surgery depends as much on effective antibiotics as it does on surgical skill— Dr. Amarchand Bajaj, senior consultant for general surgery at Sitaram Bhartia Institute
As bacteria become increasingly resistant, preserving the effectiveness of existing antibiotics is everyone's responsibility— Dr. V K Bansal, professor of surgery at AIIMS Delhi
La Conversación del Hearth Otra perspectiva de la historia
Why does it matter so much when antibiotics are given? Isn't the timing just a technical detail?
It's the difference between training an immune system and creating a breeding ground for resistance. When you give antibiotics before surgery, you're protecting the wound at the moment it's most vulnerable. After that window closes, continuing the drugs doesn't help the patient—it just gives bacteria more time to learn how to survive the medication.
So the patient feels like they're being protected, but they're actually being harmed?
Not harmed directly, but exposed to unnecessary risk. Side effects, allergic reactions, and the larger harm: you're participating in the creation of bacteria that no antibiotic can touch. That bacteria doesn't just affect you. It spreads.
How does a surgeon convince a patient to stop taking antibiotics when they feel like they need them?
That's the real challenge. Patients have been taught that more medicine is safer medicine. A surgeon has to explain that the evidence says otherwise, that international guidelines exist for a reason, and that their role in this is as important as the surgeon's.
What happens if we don't change course?
We lose the tools that made modern surgery possible. An appendectomy becomes a gamble. A routine procedure becomes life-threatening. We go backward.
Is there any sign hospitals are actually changing their practices?
Yes. Stewardship programs are spreading. But it's slow. The old habits are deep, and the pressure to "do something" for a patient is always there. Real change requires everyone—surgeons, patients, hospital administrators—to accept that sometimes doing less is doing more.