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A U E R S & T > Chapter 7 - Surgical site infection and AB > Flashcards

Chapter 7 - Surgical site infection and AB Flashcards

1
Q

What is the classification of surgical wounds? Name the 4

A
  1. clean
  2. clean-contaminated
  3. contaminated
  4. dirty
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2
Q

Which pathogen is the most commonly reported in SSI?
A) Escherichia coli
B) MRSA
C) Enterococcus faecalis
D) Coagulase-negative staphylococci

A

B) MRSA

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3
Q

What is the infection rate reported in equine fracture repair?
A) 17.6%
B) 27.6%
C) 37.6%
D) 47.6%

A

B) 27.6%

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4
Q

What is the classification of surgical site infections name the 3 existent

A
  1. superficial incisional
  2. deep incisional
  3. organ/space
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5
Q

What was the first commercially available antibiotic?

A

Penicillin

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6
Q

Which pathogen is the most commonly reported in SSI?

A

MRSA

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7
Q

What is the classification of surgical site infections name the 3 existent

A
  1. superficial incisional
  2. deep incisional
  3. organ/space
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8
Q

What type of SSI is most common in equine surgical procedures?

A

Superficial incisional

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9
Q

Describe superificial incisional describe the qualification

A

Within 30 days of operationInvolves only skin or subcutaneous tissue of the incision

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10
Q

What has to include at least in superficial incision infection?

A

purulent drainage, organism isolated in culture, 1 sign (pain, swelling, redness), diagnosis of infection by surgeon

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11
Q

qualification for deep incisional

A

Within 30 days after operation
Within 1 year if implant is in place and infection appears to be related to the operation and involves deep soft tissue (fascial and muscle layers)

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12
Q

what has to be included to be considerated deep incisional?

A

purulent drainage from deep incision but not organ space, fever, pain and abcess and dx from surgeon as deep incisional

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13
Q

define organ/space infection

A

Within 30 days after operation if no implant
Within 1 year if implant is in place and infection appears to be related to the operation and involves any part of the anatomy (organs and spaces) other than the incision, which was opened or manipulated during the operation

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14
Q

what has to be included to be considerated organ/space?

A

purulent drainage from a drain in place through space wound in organ, abscess evident of infection on direct examination during reoperation or by histo or radio exam, diagnosis by surgeon

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15
Q

How long after closure is the surgical site resistant to microorganism entry?

A

24 hours

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16
Q

What is the most common musculoskeletal pathogen in humans and animals?

A

Staphylococcus aureus

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17
Q

How many times increases the risk of SSI when hair is removed too early before surgery?

A

5.6 times

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18
Q

What is the goal of laminar airflow ventilation in operating rooms?

A

To reduce microbial contamination

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19
Q

What is the recommended air exchange rate per hour in an OR?

A

15 times

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20
Q

What is the increased risk of septic arthritis following intraarticular injection when hair is removed at the injection site?

A

20 times

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21
Q

What increases the incidence of SSI by 5.6%?

A

Preoperative hair removal with a razor

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22
Q

What is a common practice in clean-contaminated and contaminated equine procedures?

A

Changing to new instruments prior to wound closure

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23
Q

Which bacteria have virulence factors for developing biofilm?

A

Staphylococcus aureus and Enterococcus faecalis

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24
Q

What characterizes a** clean elective surgical wound**?

A

Nontraumatic, uninfected, no technique break, no inflammation, no entry to respiratory, alimentary, or genitourinary tracts.

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25
Q

When is a surgical wound considered clean-contaminated?

A

When gastrointestinal or respiratory tracts are entered without significant spillage, oropharynx or vagina are entered, or there’s a minor break in technique.

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26
Q

What criteria classify a wound as contaminated?

A

Major technique break, gross spillage from the gastrointestinal tract, fresh traumatic wound, or entry into the genitourinary or biliary tract with infected urine or bile.

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27
Q

What defines a dirty wound?

A

Presence of acute bacterial inflammation, access through “clean” tissues to a pus collection, or a traumatic wound with devitalized tissues, foreign bodies, fecal contamination, or delayed treatment.

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28
Q

Does entry into the genitourinary tract with clean urine classify as clean or clean-contaminated?

A

Clean-contaminated.

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29
Q

What makes a surgical wound clean-contaminated instead of clean?

A

Entry into the gastrointestinal, respiratory, or genitourinary tract without significant spillage, or a minor technique break.

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30
Q

Is a surgical wound with no break in technique and no inflammation considered clean?

A

Yes, it is considered clean.

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31
Q

If a wound is caused by trauma less than 4 hours old, how is it classified?

A

Contaminated.

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32
Q

In what scenario would a surgical wound be classified as dirty?

A

When there is transection of “clean” tissues to access a pus collection.

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33
Q

Are female horses at a greater risk of developing SSI after certain surgeries compared to males?

A

Yes

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34
Q

What impact does malnutrition have on patients undergoing surgery?

A

Increases risk of complication

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35
Q

How does intensive glycemic control affect SSI rates?

A

Reduces the risk

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36
Q

Are neonates more susceptible to infection due to surgery compared to adults?

A

Yes

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37
Q

What is the WHO recommendation for nasal carriers of S. aureus?

A

Treatment with mupirocin ointment

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38
Q

What should be managed prior to surgery to reduce secondary SSI?

A

Any separate site of infection

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39
Q

How does age affect the risk of septic arthritis after arthroscopy in horses?

A

Younger horses tend to be at a higher risk

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40
Q

What is the risk of developing incisional site complications in horses older than 20 years? How many times?

A

17 times greater risk

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41
Q

In horses, what factors increase the likelihood of incisional complications?

A

Age and weight

42
Q

What type of surgery is associated with an increased risk of SSI in female horses?

A

Both arthroscopic and orthopedic

43
Q

What is a major factor in SSI development in obese human patients?

A

Reduced tissue perfusion

44
Q

Waht are the surgery-related factors that represent risk factor SSI?

A

emergency procedures, duration of sx, sx skill, foreign material and stent

45
Q

What is the normal values of IgG levels in neonates prior to surgery?

A

> 800 mg/dL

Partial (IgG 400 to 800 mg/dL) or complete (IgG <400 mg/dL) failure of passive transfer

46
Q

How does hypothermia affect the risk of surgical site infection (SSI)?

A

Triples it

47
Q

What is a recommended method to maintain normothermia?

A

Use heating pads and warmers

48
Q

What is the effect of supplemental oxygen on SSI risk?

A

Reduces risk

49
Q

How does skin disruption at the surgical site affect SSI rate?

A

Increases it

50
Q

What is the effect of open fractures on infection risk compared to closed fractures?

A

4.2 times higher risk

51
Q

What is the association between silk suture material and SSI?

A

3.4 times more likely to be associated with SSI

52
Q

How does stainless steel implant material affect infection rate compared to titanium?

A

Higher rate of infection

53
Q

What is the infection rate for laparoscopic procedures in horses?

54
Q

How does the ASA Physical Status Classification System score relate to SSI development?

A

Scores greater than 2 are associated with higher risk

55
Q

What is the rate of SSI in equine orthopedic surgery?

56
Q

What is the rate of SSI in equine emergency celiotomy ?

57
Q

What is the rate of SSI in arthroscopy?

A

0.5% to 1.5%

58
Q

What is the rate of SSI in castration ?

A

2% to 3.2%

59
Q

What is the rate of SSI in laryngoplasty ?

60
Q

What is the rate of SSI in equine ortophopedic contaminated?

61
Q

What increments the risk of SII in arthroscopy?

A

draft breed and tibiotarsal joint

62
Q

Is near-far-far-near suture pattern and polygactin 910 related as risk factors for celiotomy surgery SII?

A

YES!! Lavage of linea alba, topical antibiotics to surgical site closure, incise drape for recovery, minimize surgical duration can be protective factores

63
Q

What increments the risk of laryngoplasty SII?

A

draft breed and laryngotomy

64
Q

What reduces the risk of holes in surgical gloves?

A

Double gloving

65
Q

What are the halsted’s principles?

66
Q

What type of scalpels are recommended for skin incisions?

A

Steel scalpels

67
Q

What increases the likelihood of SSI when using suture materials?

A

Using silk sutures

68
Q

What is the effect of using surgical-steel staples for skin closure?

A

Increases risk of SSI

69
Q

However in EVE 2023 Haion Incisional complications after skin closure with stainless-steel skin staples compared to nylon sutures in horses undergoing colic surger. What was the conclusion?

A

the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure

. Pregnancy and large colon intestinal lesions were risk factors for incisional complications.

including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group

70
Q

What is the role of negative pressure wound therapy postoperatively?

A

Reduces SSI

70
Q

What is a clinical indicator of acute salmonellosis in horses?

A

fever greater than 39.44°C

71
Q

What factor significantly increases the risk of developing C. difficile in horses?

A

Antimicrobial therapy

72
Q

What is the rate of catheter site inflammation and infection in horses treated for gastrointestinal disease?

A

Approximately 9%

73
Q

How long after surgery does incisional drainage typically occur, indicating SSI?

A

6 to 10 days

74
Q

What acute phase protein peaks within 7 to 10 days of injury in horses?

A

Fibrinogen

75
Q

Which acute phase protein is a reliable indicator of real-time inflammation in horses?

A

Serum amyloid A (SAA)

76
Q

What is considered a consistent and reliable indicator of osteomyelitis in horses?

A

A plasma fibrinogen level of 900 mg/dL

77
Q

How soon does Serum Amyloid A (SAA) peak after a stimulus in horses?

A

Within 6 to 8 hours

78
Q

what does a nucleated cell count (NCC) greater than 20000 cells/µL in synovial fluid indicate?

A

Possible infection

79
Q

What is considered a gold standard for diagnosing Surgical Site Infection (SSI)?

A

Microbial culture

80
Q

What is the sensitivity and specificity of tissue culture compared to swab culture in diagnosing SSIs?

A

Higher sensitivity and specificity

81
Q

What bacteria is most commonly associated with equine orthopedic infections?

A

Staphylococcus aureus

82
Q

Which bacteria are commonly isolated in neonatal infections?

A

Escherichia coli,
Actinobacillus spp.,
and Klebsiella spp.

83
Q

What is the first step in treating a surgical site infection (SSI)?

A

Establishing drainage of infected tissue

84
Q

What has been recognized as an important cause of implant-associated infection?

85
Q

what is an important factor in the timing of antimicrobial administration?

A

Administering within 1 hour of surgical incision

86
Q

Antibiotics should be redosed at ___ to____ times the half-life of the drug from the time the preoperative dose is administered

A

Antibiotics should be redosed at __1_ to__2__ times the half-life of the drug from the time the preoperative dose is administered

87
Q

When should additional intraoperative doses of antibiotics be administered?

A

Should be redosed 1 to 2 times the half-life of the drug from the time preoperative dose is administere

88
Q

What are β-lactam antibiotics mechanism of action?

A

Inhibit cell wall synthesis by binding proteins

88
Q

what is the risk associated with aminoglycoside use?

A

Nephrotoxicity

89
Q

What are cephalosporin antibiotics mechanism of action?

A

Inhibit cell wall synthesis by binding proteins

90
Q

What are aminoglicosides antibiotics mechanism of action?

A

Inhibit protein synthesis by binding to 30S ribosomal subunit

91
Q

What are metronidazoe antibiotics mechanism of action?

A

Disrupt bacterial DNA by free radicals and unstable intermediate compound

92
Q

What are fluoroquinolones antibiotics mechanism of action?

A

Inhibit bacterial DNA gyrase

93
Q

What are trimethoprim sulfonamide antibiotics mechanism of action?

A

Synergistic action to inhibit folic acid synthesis

94
Q

What are tetracyclines antibiotics mechanism of action?

A

Inhibit protein synthesis by binding to 30S ribosomal subunit

95
Q

Which antibiotics are bacteriostatic?

A
  1. Tetracyclines
  2. Chloramhenicol
  3. Macrolides

all rest is bactericidial: penicilin, cephalosporins, aminogliscosides, fluoroquinolones, metronidazole, trimethroprim sulfonamide

96
Q

What are chloramphenicol and macrolides antibiotics mechanism of action?

A

Inhibit protein synthesis by reversibly binding to 50S ribosomal subunit

97
Q

What are the adverse effects of penicilin?

A

Autoimmune hemolytic anemia anaphylaxis,
transient hypotension,
increased large intestinal motility,
cardiac arrhythmia

98
Q

What are the adverse effects of fluoroquinolones?

A

cartilage disorders in young horses (<3y)
idiosyncratic reactions is TMPS
ototoxicityis aminoglicosides
enterocolitis is cephalosporins and metronidazole

A U E R S & T (125 decks)

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