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

Barnabas Ogheneruru Okposio 1, *, Tamasanni Salawu Omeiza 2, Kehinde Dorcas Ogunleye 3, Blessing Temitope Ayanwunmi 4, Chizaram Anselm Onyeaghala 5, Ikenna Kenneth Maduike 6 and Christopher Onyema Ugwu 7

1 Department of Pharmacology, Delta State University, Abraka, Nigeria.
2 Department of Surgery, Kogi State Specialist Hospital, Lokoja Nigeria.
3 Department of Pharmacy, University of Ilorin, Ilorin, Nigeria.
4 Department of Health Education, University of Ilorin, Ilorin, Nigeria.
5 Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
6 Department of Biotechnology, School of Life Sciences, University of Bedfordshire, United Kingdom.
7 Department of Veterinary medicine, University of Nigeria, Nsukka.
 
Review
International Journal of Biological and Pharmaceutical Sciences Archive, 2025, 10(01), 246-271.
Article DOI: 10.53771/ijbpsa.2025.10.1.0072
Publication history: 
Received on 15 August 2025; revised on 22 September 2025; accepted on 24 September 2025
 
Abstract: 
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.
 
Keywords: 
Antimicrobial Resistance; Surgical Site Infections; Multidrug-Resistant Pathogens; Antibiotic Prophylaxis; Infection Prevention; Bacteriophage Therapy; Nanotechnology; Interdisciplinary Collaboration
 
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