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Surgical infections Control

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  • 1. SURGICAL INFECTIONS By Dr. Ahmed Mustafa
  • 2. SURGICAL INFECTIONS
    • Infections that require surgical treatment or
    • related to operative interventions
  • 3. SURGICAL INFECTIONS
    • Infections required surgical treatment
    • • Necrotizing soft tissue infections
    • • Infections of body cavities (peritonitis, empyema, etc.)
    • • Infections confined to an organ or tissue (abscesses, septic arthritis, cholecystitis, etc)
    • • Prosthetic device infections
  • 4. SURGICAL INFECTIONS
    • INFECTIONS RELATED TO OPERATIVE INTERVENTION
    • • Wound infections - Surgical site infections
    • • Postoperative infections
    • (peritonitis or other cavity infections)
    • • Surgical nosocomial infections
    • (pneumonia, urinary tract infections, catheter infections)
  • 5. NOSOCOMIAL INFECTIONS
    • Occurs after the initial 48 hours of admission
    • • Urinary tract infection
    • • (IV) Catheter-related infection
    • • Lower respiratory tract infection
    • • Infection via transfusion
    • • Bacteriemia and Sepsis
  • 6. PATHOGENESIS
    • DETERMINANTS OF INFECTIONS
    • Microorganism
    • Host Defenses
    • (virulance) (type&severity of immunosupression)
    • INFECTION Environment
    • (Fluids, foreign bodies, a closed unperfused space etc.)
  • 7. Infectious agent
    • The Endogenous Gastrointestinal Microflora
    • • Stomach
    • • Duodenum Aerobes and anaerobes
    • • Proximal small bowel <10 4 /mL
    • • Distal small bowel Enterobacteriaceae Enterococcus spp 10 3 -10 8 /mL Anaerobic organisms
    • • Colon Anaerobic organisms Bacteriodes fragilis 10 12 /mL
  • 8. Microbiology of Intraabdominal Infections
    • Aerobes:
    • Escerichia coli
    • Klebsiella spp.
    • Proteus spp
    • Enterobacter spp
    • Enterococcus spp
    • Anaerobes:
    • Bacteriodes spp
    • Peptostreptococcus spp
    • Clostridium spp
    • Bilophila wadsworthia
    • Fungi,Candida
  • 9. HOST DEFENSE MECHANISMS
    • Nonspecific
    • Surface Mechanical barrier
    • (skin, mucosa) Secretory barrier Immunoglobulins
    • Ciliary motion Movement
  • 10. HOST DEFENSE MECHANISMS
    • Specific
    • Cellular defense Phagocytic cells Cell-mediated immunity (PNLs, eosinophils, mononuclear cells) (T lymphocytes & macrophages)
    • Natural killer cells
    • Humoral defense Lyzozyme Immunoglobulins
    • Complement
    • Interferon
  • 11. A Susceptible host
    • Causes of Impaired Host Resistance to Infection
    • Patient ’ s Underlying Condition
    • • AIDS
    • • Remote infection
    • • Neoplasia
    • • Malnutrition
    • • Acute stress
    • (burns, trauma)
    • • Metabolic illness
    • (DM, uremia)
    • • Aging
    • • Obesity
    • • Smoking
  • 12. A Susceptible host
    • Iatrogenic
    • • Antineoplastic
    • chemotherapy
    • • Immunosuppressive
    • therapy
    • (allograft recipients,
    • autoimmune disorders)
    • • Splenectomy
  • 13. Infection Environment
    • Wound or a natural space with narrow outlets
    • Fluids, foreign bodies, a closed unperfused space etc
  • 14. Clinical finding
    • LOCAL MANIFESTATIONS OF SURGICAL INFECTIONS
    • • CELLULITIS: Spreading infection of the skin and subcutaneous tissue
    • • LYMPHANGITIS: Inflammation of the lymphatic channels in the subcutaneous tissue
    • • ABSCESS: Localized accumulation of purulent
    • material situated in the dermis or subcutaneous
    • tissue
  • 15. SURGICAL SITE INFECTION
    • The term “ surgical site infection ” now replaces “ surgical wound infection ”
    • • Superficial incisional SSI;
    • involves the skin or subcutaneous tissue
    • • Deep incisional SSI;
    • involves the deep tissue such as fascia or muscle,Organ/space SSI
  • 16. SURGICAL SITE INFECTION DEFINITION
    • Superficial Incisional Infection
    • Any incisional infection occuring within postoperative 30 days at any level above fascia described as;
    • • Presence of any purulant discharge (culture may not reveal any opponent)
    • • Any positive culture findings from primarily closed incision
    • • Deleberate incision exploration
    • • Infection diagnosis determined by the surgeon
  • 17. SURGICAL SITE INFECTION DEFINITION
    • Deep Incisional /Organ / Space Infection
    • Any infection occuring within postoperative 30 days or within postoperative one year if any implant is left
    • described as;
    • • Presence of any purulant discharge (through drains)
    • • Any positive culture findings from intraabdominal samples
    • • Spontaneous wound dehiscence
    • • Presence of abscess
    • • Infection diagnosis determined by the surgeon
  • 18. Diagnosis
    • • Redness
    • • Swelling
    • • Hyperthermia
    • • Fluctuation
    • • Purulent or turbid aspirate
  • 19. OPERATIVE WOUNDS
    • NATIONAL RESEARCH COUNCIL CLASSIFICATION OF OPERATIVE WOUNDS
  • 20. CLASSIFICATION OF OPERATIVE WOUNDS
    • CLEAN
    • • Nontraumatic
    • • No inflammation encountered
    • • No break in technique
    • • Respiratory, alimentary, genitourinary tracts not entered
  • 21. CLASSIFICATION OF OPERATIVE WOUNDS
    • CLEAN CONTAMINATED
    • • Gastrointestinal or respiratory tracts entered without significant spillage
    • • Appendectomy
    • • Oropharynx entered
    • • Vagina entered
    • • Genitourinary tract entered in absence of infected urine
    • • Biliary tract entered in absence of infected bile
    • • Minor break in technique
  • 22. CLASSIFICATION OF OPERATIVE WOUNDS
    • CONTAMINATED
    • • Major break in technique
    • • Gross spillage from gastrointestinal tract
    • • Traumatic wound, fresh
    • • Entrance of genitourinary or biliary tracts in presence of infected urine or bile
  • 23. CLASSIFICATION OF OPERATIVE WOUNDS
    • DIRTY and INFECTED
    • • Acute bacterial inflammation encountered, without pus
    • • Transection of clean tissue for the purpose of surgical access to a collection of pus
    • • Traumatic wound with retained devitalized tissue,foreign bodies, fecal contamination, and/or delayed treatment, or from dirty source.
  • 24. Treatment
    • Principles of Antibiotic Therapy
    • • Why to use antibiotics?
    • • Where is infection?
    • • What are the most probable pathogens?
    • • How about antibiotic susceptibility?
    • • Pharmacological properties
    • • Is combination of antibiotics necessary?
    • • Host factors
    • • Monitoring accuracy of therapy

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