34th Annual Scientific Meeting proceedings

For much of the 20th and 21st centuries, antibiotics have stood as one of the most critical enablers of surgical progress. They have allowed veterinary surgeons to reduce postoperative infections, manage otherwise life-threatening complications, and push the boundaries of what is surgically possible. However, this long-standing alliance is under threat. The rise of antimicrobial resistance (AMR) is no longer a looming possibility but a lived reality, and its implications for veterinary surgery are profound and far-reaching.

This talk will explore the evolving crisis of antibiotic resistance from the lens of veterinary surgery. While many discussions around AMR focus on human healthcare, the veterinary sphere, and specifically surgical disciplines within it, face distinct and pressing challenges. Resistant infections such as methicillin-resistant Staphylococcus pseudintermedius(MRSP), extended-spectrum beta-lactamase (ESBL) producing E. coli, and multi-drug resistant Pseudomonas aeruginosa are increasingly encountered in referral and first-opinion settings alike. In equine surgery, pathogens like Rhodococcus equi and resistant strains of Salmonella are equally alarming. The implications are significant: prolonged hospital stays, higher morbidity and mortality, increased costs, and ultimately, limitations on the very procedures we are able to offer.

The Surgical Battleground: Resistance in Context
Veterinary surgeons are uniquely exposed to AMR threats. Orthopaedic procedures involving implants, soft tissue surgeries, laparotomies, and management of traumatic injuries all hinge on the presumption that effective prophylactic and therapeutic antimicrobials are available. Increasingly, that presumption is flawed.

Compounding the threat are persistent gaps in diagnostic capacity. Culture and susceptibility testing results can take 2–4 days, often too slow for acute decision-making. Empirical therapy is still the norm, with a tendency towards broad-spectrum drugs such as 3rd-generation cephalosporins and aminoglycosides. Unfortunately, these are exactly the molecules where resistance is growing fastest. Newer diagnostic tools like point-of-care PCR and MALDI-TOF are promising, but remain underutilised in routine veterinary practice.

Moreover, suboptimal surgical site infection (SSI) prevention protocols, extended prophylactic regimens without justification, and inadequate infection control practices remain widespread. These are not abstract issues—they are tangible drivers of resistance and are particularly relevant to high-throughput practices and referral hospitals where surgical patient turnover is high.

The One Health Nexus
The veterinary profession cannot examine AMR in isolation. The One Health framework emphasizes the interconnectedness of human, animal, and environmental health. Antimicrobial use in veterinary settings has been directly implicated in resistance gene transmission, either through zoonotic pathogens, environmental dissemination, or indirect selection pressures. While the direct causal link to human AMR remains debated, the perception is powerful—and public and political pressure is escalating.

Legislative reforms across the European Union have already imposed severe restrictions on prophylactic use, requiring documentation and justification for antimicrobial administration. In Australia, similar frameworks are being proposed. The FDA in the United States has taken steps to phase out growth promotion use and is increasingly scrutinising veterinary access to medically important antibiotics. The direction is clear: veterinary surgeons must adapt to a landscape of increasing scrutiny and constrained access.

Future Threats: More Than Microbial
Looking forward, the threat landscape includes not just microbial evolution but also regulatory, societal, and professional changes:

• Carbapenem resistance in animal isolates has been documented. These drugs are considered last-resort antibiotics in human medicine and are strictly off-limits in most veterinary contexts. The presence of carbapenemase genes in animal pathogens is a warning signal.
• Declining public trust in veterinary antimicrobial practices risks reputational damage. Calls for "antibiotic-free" animal care, while not always feasible, are gaining traction.
• Legal implications may arise. Practitioners could face increased litigation risks for perceived overuse or inappropriate prescribing.

The pharmaceutical pipeline for new antibiotics is nearly dry. With little commercial incentive to develop veterinary-specific antimicrobials, the future will likely see fewer new options and heavier reliance on stewardship.

A Shift in Surgical Mindset: From Reaction to Prevention
If new antibiotics are not coming, then preserving the efficacy of those we have must become central to our practice. This requires a shift from reactive treatment to proactive prevention. Veterinary surgeons can and must lead this charge.

Key strategies include:

• Antibiotic stewardship tailored to surgical contexts:
  • Strict limitations on perioperative prophylaxis duration (ideally a single preoperative dose for clean procedures).
  • Empirical use only with clear rationale, followed by reassessment based on culture results.
• Improved SSI prevention protocols:
  • Adoption of evidence-based guidelines for asepsis, skin prep, draping, and surgical attire.
  • Integration of global consensus definitions for SSIs to standardise reporting and benchmarking.
• Diagnostic stewardship:
  • Routine use of culture and sensitivity in all infection cases.
  • Incorporation of rapid diagnostic tools into standard hospital workflows.
• Hospital hygiene and infection control:
  • Implementation of barrier nursing.
  • Environmental decontamination policies.
  • Auditing of infection rates and antimicrobial use.

Alternative Frontiers
In the absence of new drug classes, alternative approaches may supplement future care:

• Bacteriophage therapy, though experimental, shows promise in resistant wound infections.
• Antimicrobial peptides and host-directed therapies could modulate local immune responses and reduce bacterial colonisation.
• Probiotics and competitive exclusion strategies in foals and neonates have demonstrated potential in reducing colonisation by resistant Enterobacteriaceae.

These approaches remain largely investigational, but veterinary specialists must stay abreast of these developments to ensure future readiness.

A Call to Arms: The Role of Surgical Specialists
Veterinary surgeons are uniquely positioned to lead antimicrobial preservation efforts. This is not simply a matter of policy or compliance—it is a professional obligation. Our daily decisions directly impact the longevity of antimicrobial efficacy. Each dose prescribed without indication, each missed opportunity to culture, each unnecessary post-op course chips away at our collective defence.

As specialists, we must:

• Advocate for responsible use policies within our institutions.
• Model evidence-based prescribing behaviours.
• Train interns, residents, and students in modern AMR-aware surgical practice.
• Serve as an example function for our referring veterinarians and general practitioners.
• Engage with regulatory bodies to provide pragmatic surgical perspectives on emerging legislation.

Conclusion
The antibiotic apocalypse is neither fiction nor exaggeration. It is a gradual but accelerating erosion of our ability to control infection, underpinned by microbial evolution, systemic misuse, and sociopolitical complexity. But apocalypse is not destiny.

Veterinary surgeons stand at the crossroads. The future of surgical safety depends not only on technique and technology, but on a renewed commitment to antimicrobial stewardship. If antibiotics were once our greatest surgical ally, our legacy may well depend on how we protect them now.

“In the future, surgeons will not be judged by the lives they saved, but by the antibiotics they did.”