Surgical Infections Flashcards
Contaminated wounds closure
Delayed primary or secondary closure
Risk factors for surgical site infection
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
Silk suture shouldn’t be used in
Skin closure as it causes suture abscess (infection)
What is the Decisive period
Inflammatory response takes 4 hours to be mobilised after a breach in the epithelium
What is given for the decisive period
Prophylactic antibiotics. Given about the MIC90. Minimum inhibitory concentration for the microorganisms
Types of surgical site infections
1- superficial surgical site infection
2- deep surgical site infection
3- organ space infection
Types of infection
1- primary. From an endogenous source.
2- secondary. From an exogenous source. Hospital acquired infections
Types of HAIs
1- respiratory ( ventilator associated pneumonia)
2- uti (urinary catheter)
3- bacteremia (vascular catheter)
4- surgical site infections
Major and minor surgical site infections
Major: excessive pus, delayed return home, systemic signs
Minor: may be pus, but no delayed return home or systemic signs
Scoring systems to assess intensity of surgical site infection
1- Southampton scoring system
2- ASEPSIS
CDC recommendation for follow up post-surgery
30 days for non prosthetic surgery
1 year for prosthetic surgery
Organism in acute abscess
Staph A
Organisms in chronic abscess, sinus and fistula formation and calcification
1- Tb
2- actinomyces
How many days after surgery does an abscess usually form
7-10 days
Treatment of abscesses
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
Partly treated abscess with antibiotics
Antibioma
Abscess in deep cavity like pleura or peritoneum
Guided aspiration with CT, MRI, ultrasound
Cellulitis
Nonsuppurative, poorly localised, causes SIRS with negative blood culture
Organisms causing cellulitis
Beta hemolytic streptococcus, staph, clostridium perfringens
Lymphangitis
Painful red streaks. Painful draining lymph nodes
SIRs
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
MSOF
Multiple system organ failure is the end stage of MODS
Sepsis
SIRS with a documented infection.
Synergistic spreading gangrene/ subdermal gangrene/ necrotising fasciitis )
Abdominal wall- Meleney’s syngergistic hospital gangrene
Scrotum- fourniers gangrene
