Surgical Infections

Question 1

who is at risk of SSI

Medical co-morbidities

Answer 1

Tobacco use
DM
malnutrition
older age
obesity
anemia
STAPH CARRIERS

Question 2

What are the categories of SSI

Answer 2

superficial incisional (skin and subQ)
Deep incisional (muscle/fascia)
Organ space (does not always include skin changes)

Question 3

What are the primary bacteria of origin for SSI

Answer 3

Gram Positive:
- S. Aureus
- s. epidermidis

Gram Negative:
- e.coli
- h.influenza
- k.pneumoniae

Question 4

What are the common cardiac SSI organisms

Answer 4

S. aureus
coagulase negative staph
propionibacterium acnes

Question 5

What are common Thoracic SSI organism

Answer 5

S.aureus
s. epidermidis

Question 6

What are common GI Tract SSI organisms

Answer 6

e.coli
proteus spp
klebsiella spp,
staph spp
strep spp
enterococci
bacteriodes
clostridium

Question 7

What are common HEENT SSI organism

Answer 7

staph spp
strep spp
bacteriodes
peptrostretococcus

Question 8

what are common Neuro SSI organisms

Answer 8

S. aureus
P. acnes
caogulase negative staph

Question 9

What are common Ortho SSI organisms

Answer 9

S. aureus
coagulase negative staph
beta-hemolytic strep
gram negative bacili

Question 10

What are common urologic (lower tract) SSI organisms

Answer 10

Gram negative bacilli
Enterococci

Question 11

what are common other urologic SSI organisms

Answer 11

S.aureus
Staph epidermidis
E. coli
other gram negative bacilli
pseudomonas

Question 12

what are common vascular SSI organisms

Answer 12

S. aureus
s/epidermidis
e.coli

Question 13

what are common Plastics SSI organisms

Answer 13

S. aureus
other staph spp
strep spp
serratia marcescens

Question 14

What are signs and symptoms of SSI

Answer 14

pain at surgical site
erythema/edema beyond normal post-op
cellulitis
+/- purulent drainage
+/- abscess
+/- wound dehiscence
+/- fever

Question 15

how is an SSI diagnosed

Answer 15

clinical symptoms + positive wound culture

Question 16

what is the treatment of SSI

Answer 16

mainstay is source control
- drain purulent material
- debride infected/devitalized tissue
- remove any ‘foreign bodies’
- I&D

augmented with empiric abx

Question 17

what are preoperative interventions for prevention of SSI

Answer 17

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)

Question 18

what are intraoperative interventions for prevention of SSI

Answer 18

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

Question 19

what things do we NOT have to do to prevent SSI

Answer 19

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

Question 20

what is the #1 cause of SSI overall

Answer 20

S. aureus

Question 21

what is the first line antibiotic prophylaxis med

Answer 21

Cephalosporin (primarily Cefazolin)

second line: clindamycin of Vancomycin

Question 22

If there are concerns for anaerobes what should be added to the antibiotic prophylaxis

Answer 22

metronidazole