Surgical Infections

Question 1

Contaminated wounds closure

Answer 1

Delayed primary or secondary closure

Question 2

Risk factors for surgical site infection

Answer 2

1- diabetes. Uremia. Jaundice. Obesity. Malnutrition.
2- aids . Chemotherapy. Radiotherapy. Steroids.
3- colonisation and translocation of upper git bacteria after suspension of enteral feed to the mesenteric nodes releasing endotoxins causing multiple organ dysfunction syndrome and systemic inflammatory response syndrome
4- local ischemia or systemic shock
5- foreign body such as sutures and drains
6- dead space, hematoma

Question 3

Silk suture shouldn’t be used in

Answer 3

Skin closure as it causes suture abscess (infection)

Question 4

What is the Decisive period

Answer 4

Inflammatory response takes 4 hours to be mobilised after a breach in the epithelium

Question 5

What is given for the decisive period

Answer 5

Prophylactic antibiotics. Given about the MIC90. Minimum inhibitory concentration for the microorganisms

Question 6

Types of surgical site infections

Answer 6

1- superficial surgical site infection
2- deep surgical site infection
3- organ space infection

Question 7

Types of infection

Answer 7

1- primary. From an endogenous source.

2- secondary. From an exogenous source. Hospital acquired infections

Question 8

Types of HAIs

Answer 8

1- respiratory ( ventilator associated pneumonia)
2- uti (urinary catheter)
3- bacteremia (vascular catheter)
4- surgical site infections

Question 9

Major and minor surgical site infections

Answer 9

Major: excessive pus, delayed return home, systemic signs
Minor: may be pus, but no delayed return home or systemic signs

Question 10

Scoring systems to assess intensity of surgical site infection

Answer 10

1- Southampton scoring system

2- ASEPSIS

Question 11

CDC recommendation for follow up post-surgery

Answer 11

30 days for non prosthetic surgery

1 year for prosthetic surgery

Question 12

Organism in acute abscess

Answer 12

Staph A

Question 13

Organisms in chronic abscess, sinus and fistula formation and calcification

Answer 13

1- Tb

2- actinomyces

Question 14

How many days after surgery does an abscess usually form

Answer 14

7-10 days

Question 15

Treatment of abscesses

Answer 15

1- aspiration
2- incision and drainage
3- left open to heal by secondary intention and no antibiotics given
4- if closed then antibiotics are given

Question 16

Partly treated abscess with antibiotics

Answer 16

Antibioma

Question 17

Abscess in deep cavity like pleura or peritoneum

Answer 17

Guided aspiration with CT, MRI, ultrasound

Question 18

Cellulitis

Answer 18

Nonsuppurative, poorly localised, causes SIRS with negative blood culture

Question 19

Organisms causing cellulitis

Answer 19

Beta hemolytic streptococcus, staph, clostridium perfringens

Question 20

Lymphangitis

Answer 20

Painful red streaks. Painful draining lymph nodes

Question 21

SIRs

Answer 21

1- hyperthermia (greater than 38 degree Celsius) or hypothermia (less than 36 degree Celsius)
2- tachycardia (greater than 90 beats per min) or tachypnea(greater than 20 breaths/min)
4- white cell count greater than 12 or less than 4 into 10 raised to the power 9

Question 22

MSOF

Answer 22

Multiple system organ failure is the end stage of MODS

Question 23

Sepsis

Answer 23

SIRS with a documented infection.

Question 24

Synergistic spreading gangrene/ subdermal gangrene/ necrotising fasciitis )

Answer 24

Abdominal wall- Meleney’s syngergistic hospital gangrene

Scrotum- fourniers gangrene

Question 25

Prophylaxis of clostridium perfringens

Answer 25

Benzylpenicillin

Question 26

Treatment of clostridium perfringens

Answer 26

Benzylpenicillin and debridement of tissue

Question 27

When are prophylactic antibiotics given

Answer 27

Induction of anesthesia

Question 28

Further antibiotics are given if

Answer 28

1- surgery prolonged
2- excessive blood loss
3- contamination during surgery
(Given At 4 hourly intervals)

Question 29

Prophylaxis after dental surgery in patients with prosthesis

Answer 29

Amoxicillin

Question 30

Prophylaxis after urological instrumentation in patients with prosthesis

Answer 30

Gentamycin