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CP3 @ UoN - Medicine & Surgery > Surgery - Surgical Infection & Antibiotics > Flashcards

Surgery - Surgical Infection & Antibiotics Flashcards

1
Q

What general factors contribute to wound infection following a surgical procedure?

A 
Age
Malnutrition
Immunosuppression
Malignancy
Obesity
Hypoxia
Anaemia
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2
Q

What local factors contribute to wound infection following a surgical procedure?

A 
Type of surgery (clean vs contaminated)
Length of procedure
Residual local malignancy
Foreign body insertion
Ischaemia
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3
Q

What microbiological factors contribute to wound infection following a surgical procedure?

A

Lack of a/b prophylaxis

Virulence of organism

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4
Q

What are the four types of operative procedure, in reference to their potential for infectious complications?

A

Clean
Potentially-contaminated
Contaminated
Dirty

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5
Q

Describe a clean operative procedure

A

Operation does not enter colonised viscus or lumen of body
SSI risk from contaminants from environment (2-5%)
-S. aureus most common

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6
Q

Describe a potentially-contaminated procedure

A

Operation enters colonised viscus or body cavity but under elective & controlled conditions
SSI risk from endogenous bacteria (10%)

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7
Q

Describe a contaminated procedure

A

Contamination present at surgical site w/o obvious infection

SSI risk from endogenous bacteria (20%)

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8
Q

Describe a dirty procedure

A

Surgery performed where active infection already present

SSI risk from established pathogens (30%)

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9
Q

What are the three types of surgical site infection?

A

Superficial Incisional
Deep Incisional
Organ/space

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10
Q

What is a Superficial Incisional SSI?

A

Infection of skin & s.c. tissue of incision

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11
Q

What is a Deep Incisional SSI?

A

Infection of deep tissues (muscle/fascial) and includes organ/space SSIs draining through the incision

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12
Q

What is an Organ/Space SSI?

A

Infection of any site involved in the operation other than the incision

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13
Q

Which patients should be given prophylactic infection?

A

Pts at high risk of infection

Pts where an infection would be serious, even if risk is low

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14
Q

What determines choice of antibiotic in surgical pts?

A

Likely infecting organisms
Hospital guidelines
-cefuroxime & metronidazole

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15
Q

What is impetigo?

A

Superficial purulent infection caused by staph/strep w/ golden crust on erythematous base

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16
Q

How should impetigo be managed?

A

Swab to confirm organism

Treat w/ topical mupirocin/fusidic acid

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17
Q

What is ecthyma?

A

Purulent skin infection caused by staph/strep. Ulceration under a crust

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18
Q

How should ecthyma be managed?

A

Associated w/ poor hygiene & malnutrition

Treat by guidelines

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19
Q

What is erythrasma?

A

Mildly itchy eruption b/w toes/flexures caused by corynebacterium

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20
Q

How should erythrasma be managed?

A

Topical miconazole OR

Oral erythromycin

21
Q

What is Folliculitis?

A

Pustular infection caused by staph

-can be deep or superficial

22
Q

How should folliculitis be managed?

A 
Oral flucloxacillin (if superficial)
Tetracycline/erythromycin (if deep)
23
Q

What is Staphylococcal Scalded Skin Syndrome?

A

Fever, irritability & skin tenderness THEN

Erythema & blistering (after 24-48hrs)

24
Q

How should SSSS be managed?

A

Bacterial swab from nose/throat

IV flucloxacillin

25
Q

What is Cellulitis?

A

Infection of s.c. tissue due to staph

26
Q

What is Erysipelas?

A

Infection of dermis due to staph
Raised erythematous edge
Often on face

27
Q

What are Viral Warts?

A

Smooth, skin coloured papules w/ irregular hyperkeratotic surface
-resolve spontaneously

28
Q

What is Molluscum Contagiosum?

A

Poxvirus causing umbilicated papules

-resolve spontaneously over months

29
Q

What is Ringworm?

A

Erythematous annular lesions w/ central clearing

30
Q

How should Ringworm be managed?

A

Topical terbinafine/ketoconazole

-may be systemic in widespread disease

31
Q

What is Scabies?

A

Scabietic burrows on edges of fingers/sides of hands/feet

32
Q

How should Scabies be managed?

A

Topical permethrin/malathion

-give to all physical contacts

33
Q

What are the two broad types of gangrene?

A

Anaerobic

Synergistic (necrotising fasciitis)

34
Q

What causes anaerobic gangrene?

A

Clostridium perfringens in soil/faeces

  • arises from trivial injury
  • often in immunocompromised pts
35
Q

How does anaerobic gangrene present?

A

Gas in tissues & skm (crepitus)
Oedema
Spreading gangrene w/ systemic upset

36
Q

How should anaerobic gangrene be managed?

A

Resuscitation
Aggressive debridement
IV penicillin + metronidazole

37
Q

What causes synergistic gangrene?

A

Aerobes & synergistic anaerobes infect wound/surgical site

38
Q

How does synergistic gangrene present?

A

Severe wound pain
Gas in tissues
Extensive subdermal gangrene

39
Q

How should synergistic gangrene be managed?

A

Debridement
Antibiotics
Systemic support

40
Q

What are the causes of post-op fever?

A 
Mild pyrexia common post-op (response to tissue injury/stress)
Severe pyrexia (infection)
41
Q

What general steps should be taken when reviewing a patient with post-op fever?

A

Review general obs, urine output etc.
Inspect wound for SSI/haematoma
Inspect cannula sites for thrombophlebitis/infection
Examine chest for infection/infarction/acute heart failure
Examine legs for DVT
Consider other sources of infection

42
Q

When is a routine isolation unit used?

A

Protect other pts/staff from pts infection

43
Q

When are reverse isolation units used?

A

Protect pts from infections carried by staff/visitors/pts

-used when pts have decreased immunity

44
Q

What are the common locations of an intra-abdominal abscesses?

A

Alongside organ of origin
Pelvic
Subphrenic

45
Q

What are the clinical features of an intra-abdominal abscesses?

A 
Malaise
Anorexia
Swinging pyrexia
Tachycardia
Possible mass
46
Q

How are intra-abdominal abscesses investigated?

A

CT abdo/pelvis

47
Q

How are intra-abdominal abscesses managed?

A

IV empirical a/b
Radiologically guided drainage
-surgical drainage as last line

48
Q

How should a superficial s.c. abscess be drained?

A

Performed under GA
Fluctuance incised
Blunt probing ensures all loculi drained

CP3 @ UoN - Medicine & Surgery (135 decks)

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