Surgical Infections Flashcards
who is at risk of SSI
Medical co-morbidities
Tobacco use
DM
malnutrition
older age
obesity
anemia
STAPH CARRIERS
What are the categories of SSI
superficial incisional (skin and subQ)
Deep incisional (muscle/fascia)
Organ space (does not always include skin changes)
What are the primary bacteria of origin for SSI
Gram Positive:
- S. Aureus
- s. epidermidis
Gram Negative:
- e.coli
- h.influenza
- k.pneumoniae
What are the common cardiac SSI organisms
S. aureus
coagulase negative staph
propionibacterium acnes
What are common Thoracic SSI organism
S.aureus
s. epidermidis
What are common GI Tract SSI organisms
e.coli
proteus spp
klebsiella spp,
staph spp
strep spp
enterococci
bacteriodes
clostridium
What are common HEENT SSI organism
staph spp
strep spp
bacteriodes
peptrostretococcus
what are common Neuro SSI organisms
S. aureus
P. acnes
caogulase negative staph
What are common Ortho SSI organisms
S. aureus
coagulase negative staph
beta-hemolytic strep
gram negative bacili
What are common urologic (lower tract) SSI organisms
Gram negative bacilli
Enterococci
what are common other urologic SSI organisms
S.aureus
Staph epidermidis
E. coli
other gram negative bacilli
pseudomonas
what are common vascular SSI organisms
S. aureus
s/epidermidis
e.coli
what are common Plastics SSI organisms
S. aureus
other staph spp
strep spp
serratia marcescens
What are signs and symptoms of SSI
pain at surgical site
erythema/edema beyond normal post-op
cellulitis
+/- purulent drainage
+/- abscess
+/- wound dehiscence
+/- fever
how is an SSI diagnosed
clinical symptoms + positive wound culture
what is the treatment of SSI
mainstay is source control
- drain purulent material
- debride infected/devitalized tissue
- remove any ‘foreign bodies’
- I&D
augmented with empiric abx
what are preoperative interventions for prevention of SSI
pt cleansing night before sx
antibiotic prophylaxis prior to skin incision
shaving of operative site with electric clippers, not razor
preop skin prep with alcohol based prep
tx of known colonization with MRSA (mupirocin)
what are intraoperative interventions for prevention of SSI
tight intra-operative glycemic control
maintaining normothermia
maintaining oxygenation
ensuring adequate hemostasis
minimizing tissue trama, removing devitalized tissue
closing any deadspace on incision closure, wound closing without tension
post op: timely removal of any closed suction drains
what things do we NOT have to do to prevent SSI
withhold blood tranfusion
use topical agents in surgical site
use topical agnets on incisional site after closure
give additional abx >24 hrs after skin closure
routine use of drains
what is the #1 cause of SSI overall
S. aureus
what is the first line antibiotic prophylaxis med
Cephalosporin (primarily Cefazolin)
second line: clindamycin of Vancomycin
If there are concerns for anaerobes what should be added to the antibiotic prophylaxis
metronidazole
