Infection, Obesity, and Smoking

Thankfully for the readers, most of the scientific literature I read doesn't make it into this blog. But one paper about a comparative drug trial had some very interesting results. In short, obesity and smoking are significant risk factors for post-operative infections.

The article, published in the NE Journal of Medicine, is a comparative study of which is the better antibiotic use to use after colorectal surgery to prevent infections: etrapenem or cefotetan. While cefotetan is typically used, etrapenem was was associated with significantly fewer post-operative complications. Interestingly, the use of etrapenem, while lowering infections overall, resulted in a higher frequency of Clostridium difficile infections.

Now, this probably isn't too interesting (or interesting at all) unless you either perform colorectal surgeries, or are about to undergo one. But the authors also examined which patient characteristics were associated with a higher likelihood of infections. Not surprisingly, getting the patient's own feces into sterile parts of the body cavity was more likely to result in infection (during surgery, erm, shit happens...). Not exactly surprising. Also, patients who had heart disease were more likely to get infections--these patients are probably partially immunocompromised. Also, not shaving the incision site immediately before surgery increased infection rate. Hair and dead skin cells, while not as bad as shit, are still obvious sources of contamination.

But two other factors were significant. First, smoking also increased infection rates almost two-fold (a previous history of smoking did not affect the probability of infection). Second, obesity, defined as a BMI of greater than 30, also increased the rate of infection two-fold. Most of the additional infections associated with obesity appear to be surgical site infections, which is a common trend.

My point is not to further dump on smokers and the obese (although these are risk factors for many diseases--I don't want my readership getting sick on me...). Rather, it's that infection control--and the lack thereof that contributes to the evolution of antibiotic resistance--should not be viewed in isolation, but, instead, should consider the health of the patients. To be snarky, a good way to prevent post-surgical infections is to only perform surgeries on thin, non-smokers (I'm kidding--obviously, you can't do that).

Controlling and reducing infectious disease, including antibiotic resistance, should be viewed more as a public health problem in the same way obesity and smoking are, and less as a symptom to be treated.