Infection in surgery Flashcards
Differentials
UTI Prostatitis Pyelonephritis Ureteric colic STI BPH
Investigations
DRE
Abdo exam
Basic observations
Bedside:
- Urine dipstick
- Urine culture
Bloods:
- FBC
- CRP
- U+Es
- Pregnancy test
Imaging:
- Bladder scan - retention
- AXR - calculi
- USS of kidneys - hydronephrosis
Acute bacterial prostatitis cause
Commonly occurs due to ascending urethral infection
Causative organisms of acute bacterial prostatitis
E. Coli
Enterobacteriaceae
Chlamydia
Gonorrhoea
Presentation of acute bacterial prostatitis cause
Prostate pain with LUTS
- pain on ejaculation
- lower back pain
- perineal pain
Risk factors for acute bacterial prostatitis
Indwelling catheters
Phimosis or urethral stricture
Recent surgery, cystoscopy or transrectal prostate biopsy
Immunocompromised
Acute cystitis presentation
More common in women
LUTS and suprapubic pain
No perineal pain
Ureteric calculi presentation
Loin to groin pain
Pain in the penis or testes
Non visible haematuria
Bladder cancer presentations
LUTS
Painless haematuria
Mx of acute bacterial prostatitis
1st line: ciprofloxacin or trimethoprim
If systemically unwell - IV abx
When is specialist input required
DM patients
Prostate abscess
Long term catheters
Immunocompromised
Differentials for abdo pain following general surgery
Anastomotic leak
Adhesions - obstruction
Perforation
DRE post op
DRE should not be performed if suspected colonic anastomosis
Ix for post op abdo pain
Abdominal examination
Bloods
- Group + save
- ABG
- CRP
- Clotting
Imaging:
- Erect CXR - perforation
- CT AP with contrast
Anastomotic leak
Leak of luminal contents from a surgical join
Anastomotic leak presentation
Pt that is not progressing as expected
Or who deteriorates after surgery
5 - 7 days post op
Risk factors for anastomotic leak
Medication - corticosteroids
Smoking
Diabetes
Alcohol
Obesity
Management of anastomotic leak
NBM
Broad spectrum abx
Catheterise
< 5cm - IV abx
> 5 cm - percutaneous drainage
Septic - laparotomy and stoma
What factors effect management of anastomotic leaks?
- Size of leak
- Extent of leak
- Physiological status of pt
Post op surgical site pain differentials
Wound dehiscence
Chronic pain
Wound infection
Presentation of Surgical site infection
Searing pain
Localised and worse on touch
Gradual onset and then constant
Pus or discharge
Wound dehiscence
5 - 7 days post op
Persistent pyrexia
Ix for Post op surgical site pain
Abdominal examination
Check wound site
Swabs inside wound
Bloods
- FBC
- CRP
Blood culture if systemically unwell
Common bacterial cause of wound infection
Staphylococcus aureus
Risk factors for post operative surgical site infection
DM patients
Malnourished pts
Renal failure
Current smokers
Post op fever causes
- Wind - pneumonia/ atelectasis
- Water - UTI/ IV line infection
- Wound
- Walk - VTE
- Wonder drugs
Mx of surgical site infection
Conservative:
- remove sutures or clips
- allow wound drainage
- pack wound if necessary
- call senior
Pharmacological:
- Oral or IV flucloxacillin
- If contraindicated - clarithromycin/ doxycycline
- severe: oral co - amoxiclav or clindamycin
MRSA mx
IV vancomycin
How to prevent surgical site infections
Prophylactic abx
Remove hair immediately before surgery
Monitor wounds closely post op
Tissue viability nursing staff advice
Osteomyelitis on Xray
Osteopenia
Periosteal thickening
Endosteal scalloping
Focal cortical bone loss
Mx of osteomyelitis
IV flucloxacillin - 6 weeks
Consider rifampicin for initial 2 weeks
Complications of osteomyelitis
Sepsis
Recurrent infections
Chronic osteomyelitis
Growth disturbance in children
Differentials for osteomyelitis
Vertebral fracture
Osteoarthritis
Potts disease
