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MBBS 3: Surgery > Surgical Infections > Flashcards

Surgical Infections Flashcards

1
Q

What is an infection?

A

Invasion of the body by pathogenic microorganisms and reaction of the host to organisms and their toxins

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2
Q

What is a surgical infection?

A

an infection requiring surgical treatment and has developed before or as a complication of surgical treatment
< 30 days of surgery (or within a year in the case of implants)

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3
Q

Name types of infections in surgery?

A
  1. Wound infections
  2. Surgical site infections
    - Superficial
    - Deep
  3. Soft tissue infections
    - Cellulitis
    - Subcutaneous abscesses
    - Peri-anal or perirectal abscesses
    - Pyomyositis
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4
Q

What are superficial incisional surgical site infections?

A
  • 30 days of procedure
  • involve only the skin or subcutaneous tissue around the incision.
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5
Q

What are deep incisional surgical site infections?

A
  • < 30 days of procedure (or one year in the case of implants)
  • are related to the procedure
  • involve deep soft tissues, such as the fascia and muscles.
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6
Q

Name local factors influencing surgical site infections: surgical + paient?

A
  1. High bacterial load
  2. Wound hematoma
  3. Necrotic tissue
  4. Foreign body
  5. Obesity
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7
Q

Systemic factors contributing to infection?

A
  1. Advanced age
  2. Shock
  3. Diabetes
  4. Malnutrition
  5. Alcoholism
  6. Steroids
  7. Chemotherapy
  8. Immuno-compromise
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8
Q

Surgical risk factors for infections?

A
  1. Type of procedure
  2. Degree of contamination
  3. Duration of operation
  4. Urgency of operation
  5. skin preparation
  6. operating room environment
  7. Antibiotic prophylaxis
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9
Q

Pathogenicity of bacteria?

A
  1. exotoxins
  2. endotoxins
  3. resist phagocytosis
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10
Q

Exotoxins?

A

specific, soluable proteins, remove cytotoxic effects
e.g. Tetani, strept pyrogens

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11
Q

Endotoxins?

A

part of gram neg bacteria wall
e.g. E.coli

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12
Q

Resist phagocytosis?

A

protective capsule
i.e klebsiela and strept. pneumonia

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13
Q

What is host resistance?

A
  1. Intact skin (surgery/ trauma breaks it)
  2. Immunity : cellular, antibodies
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14
Q

How to prevent surgical infections?

A
  1. Have good host defences
  2. Minimise pathogens during surgery
  3. Good surgical techniques
  4. Perioperative surgical care
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15
Q

Classification of the type of surgery?

A
  1. clean
  2. clean contaminated
  3. contaminated
  4. dirty
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16
Q

What is a clean surgery?

A
  • uninfected operative (non traumatic) wound
  • no acute inflammation
  • no entry to internal organs and no break in aseptic technique
    e.g. hernia repair, mastectomy, vascular
    Note: infection rate is 2%
17
Q

What is a clean-contaminated surgery?

A
  • opening to internal organ but minimal or no spillage of contents
  • respiratory, GI, GU tract entered with minimal contamination
  • no evidence of infection or major breakage in aseptic technique
    e.g. cholecystectomy, lysis of adhesions, gastrectomy, hysterectomy
    Note: infection <10%
18
Q

What is a contaminated surgery?

A
  • open, fresh, traumatic wounds
  • opening to internal organs with inflammation or uncontrolled spillage of contents
  • minor break in sterile technique
    e.g. colectomy for obstruction, rupture appy, emergent bowel resect
    Note: 20%
19
Q

What is dirty surgery?

A
  • open, traumatic, dirty wounds
  • traumatic perforation of hollow viscus with peritonitis
  • purulent inflammation present
  • intraperitoneal abscess formation : frank pus in field
    e.g. perforated appendicitis, intestinal fistula resection
    Note: infection rate is 28-70%
20
Q

Surgical site infections and tissue layers affected?

A
  1. superficial incisional
    - skin + subcutaneous tissue
  2. deep incisional
    - skin, subcutaneous tissue + deep and soft tissue (fascia and muscle)
  3. organ space
    - organ space
21
Q

What is necrotizing fascitis?

A

It is necrosis of superficial fascia overlying the skin
- Worse in diabetics
- Starts as cellulitis
e.g. Polymicrobial: strept, staph, enterococci, enteriobacterioceae

22
Q

Common sites for necrotizing fascitis?

A

1.Abdomen - meleny
2. perinum - fourniers
3. limb

23
Q

Treatment of necrotizing fascitis?

A
  1. Debridement
  2. wound dressing antibiotics
  3. skin grafting
24
Q

Incidence of SSIs when you take into account opening and re-closure times of an infected wound?

A
  1. opening and reclosure at once - 50%
  2. opening and re-closure after 2 days - 20%
  3. opening and re-closure after 4 days - 5%
  4. opening and re-closure after 9 days - 10%
25
Q

Principles of surgical infections treatment?

A
  1. Debridement: necrotic tissue
  2. Drainage
  3. Removal: source of infection
  4. Supportive measures: antibiotics, fluids, limb elevation, daily wound care
26
Q

Types of healing?

A
  1. Primary intention
  2. Secondary intention
  3. Delayed primary intention
27
Q

Primary retention?

A
  • clean incised wound/surgical wound
  • wound closed by suturing, skin grafting or flap closure
28
Q

Secondary intention?

A
  • highly contaminated wound or tissue loss
  • wound is left open to heal
  • closed by reepitheliazation
29
Q

Tertiary intention?

A
  • contaminated wound
  • treated by repeated debridement
  • wound is closed by suturing skin grafting flap
30
Q

What is cellulitis?

A

acute infection of loosing connective tissue

31
Q

What pathogens can cause cellulitis?

A

B-hemolytic Streptococci or Staphylococci aureus

32
Q

Clinical presentation of cellulitis?

A

redness of skin, swilling and boundless

33
Q

What is anaerobic cellulitis?

A

localized infection involving skin and soft tissue and is caused by clostridia alone or with anither bacteria
- crepitation

34
Q

Treatment of cellulitis?

A
  1. antibiotics
  2. incision and draninage
35
Q

What are abscesses?

A

Characterized by a necrotic center without a blood supply and composed of debris from local tissues, dead and dying leukocytes, components of blood and plasma and bacteria
- This semiliquid central portion (Pus) is surrounded by a vascularized zone of inflammatory tissue

36
Q

What is the treatment of abscesses?

A
  1. Incision and drainage
  2. Antibiotics
37
Q

What is pyomyositis?

A
  • A deep infection in a muscle most commonly the thigh (quadraceps)
  • Usually S aureus infection
  • Usually a chronic process, hematogenous seeding followed by infection leading to abscess over the course of several weeks

MBBS 3: Surgery (42 decks)

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