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Wound infection

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  • 1. WOUND INFECTION COLLEGE OF DENTISTRY 2012-2013 GENERAL PATHOLOGY
  • 2. HISTORYWINE &VINEGAR;USED AS ANTISEPTIC TO CLEANTHE WOUNDS.MAGIC BULLET:IT IS THE CONCEPT OF PRODUCTIO-N OF A CHEMICAL WHICH KILLS MICRORGANISMCELL AND SPARING THE AFFECTED HUMAN CELLS.FIRST ANTIMICROBIAL DISCOVERED IS SULPHANA-MIDES,THEN PENICILLINS.INSPITE OF GREAT ANTIMICROBIALS MANUFACTU-RED ,SOME BACTERIA PRODUCING SPECIAL ENZY-ME THAT DESTROY THE ANTIMICROBIALS.
  • 3. CONT,D MOST OF ANTIMICROBIALS HAVE BETA LACT-AM RING WHICH IS DESTROYED BY AN ENZYMECALLED BETA LACTAMASE PRODUCED BY SOMEBACTERIA.TO PREVENT INFECTION BETTER THAN TO TREAT ITi.e. PROPHYLAXIS.1-ASEPTIC TECHNIQUES.2-ANTIBIOTICS PROPHYLAXIS ,BEFORE ,DURING AND AFTER SURGERY.3-DELAYED CLOSURE OF A CONTAMINATED WOUND IS A SAFE VALVE TO PREVENT INFECTION.
  • 4. BODY RESISTANCE TO INFECTION--MECHANICAL:SKIN,MUCOUS MEMBRANE INTIGRITY.--CHEMICAL:LIKE ACIDITY IN THE STOMACH. SKIN SECRAETIONS TO KILL SOME ORGANISMS.---HUMORAL:OPSONIN,COMPLEMENT SUBSTANCE.---CELLULAR:MACROPHAGE,POLYMORPHS.
  • 5. WOUND INFECTIONDEFINTION:IT IS INVASION OF MICRORGANISM THR-OUGH TISSUE AFTER BREAKDOWN OF LOCAL AND/OR SYSTEMIC HOST DEFENCE ,WITH PRODUCTIONOF LOCAL INFLAMMATORY REACTION.WOUND INFECTION COULD BE AT THE TIME OF INJU-RY OR LATER ON.IT DEPENDS ON HOST RESISTANCE,AND VIRULENCE OF THE MICRORGANISM.
  • 6. PATHOLOGICAL & CLINICAL CONDITIONS RELATED TO INFECTIONINFECTION:LOCAL INFLAMMATION DUE TO INVASIONOF VIRULENT MICRORGANISM.SEPSIS:IT IS LOCAL INFECTION + SYSTEMIC MANIFEST-ATIONS –SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS).SIRS WHEN 2 OR MORE OF THE FOLLOWINGS PRESENT: -TEMPERATURE=MORE THAN 38 OR LESS THAN 36 DEGREE CENTIGRADE.-W.B.C. MORE THAN 12,000 OR LESS THAN 4,000.
  • 7. CONT,DPULSE RATE:MORE THAN 90/MINT.RESPIRATORY RATE:MORE THAN 20/MINT.THE PATHOGENESIS OF SIRS IS REALEASE OF CYTOKIN-ES (INTERLEUKINS,TUMOR NECROSIS FACTOR -TNF) FROMMACROPHAGES AND NEUTROPHILS.SIRS COULD BE SEEN IN MULTIPLE TRAUMA,BURN,ACUTE PANCREATITIS,IN ADDITION TO SEPSIS .SEVER SEPSIS:SEPSIS+ MODS(MULTIPLE ORGAN DYSFUNCTION SYNDROME),ONE OR MORE ORGAN DYSFUNCTION.LIKE ARDS (ACUTE RESPIRATORY SYNDROME),,RENAL(ACUTE TUBULAR NECROSIS), HEPATIC (COAGULATION ABNORMALITY&HYPERBILIRUBINAEMIA).AGAIN THESE EFFECTS DUE TO RELEASE OF INTERLEUKINS&TNF.
  • 8. CONT,DSEPTIC SHOCK:SEVER SEPSIS + HYPOTENSION ANDEND IN MSOF(MULTIPLE SYSTEMIC ORGAN FAILURE).DEFINITION OF INFECTED STATES IN SUMMARY:SSSI :IT IS WOUND INFECTION.SIRS :BODY SYSTEMIC RESPONSE TO INFECTION.MODS:EFFECT OF INFECTION ON WHOLE BODY .MSOF: END STAGE OF UNCONTROLLED MODS.
  • 9. RISK FACTORS INCREASING RISK OF INFECTIONLOCAL FACTORS:1-POOR BLOOD FLOW LIKE ATHEROSCLEROSIS.2-FOREIGN BODY.3-POOR SURGICAL TECHNIQUE:DEAD SPACE,HAEMATOMA,TOO MUCH DISSECTION WITH DEVASCULARISATION.GENERAL FACTORS:1-AGE .2- MALNUTRITION.OBESITY,HYPOPROTEINAEMIA,ANAEMIA.3-METABOLLIC:URAEMIA,JAUNDICE,DIABETIS MELLITUS.4-IMMUNE DEFCIENCY:AIDS,CANCER,CHEMOTHERAPY,RADIOTHERAPY OR STEROIDS THERAPY.
  • 10. OPPORTUNISTIC INFECTIONIT IS INFECTION BY AVIRULENT MICRORGANISM,WH-EN THE BODY RESISTANCE ,OR DEFENCE SYSTEM,IS COMPROMISED ,OR BROKEN AS IN SEVER BURN,AIDS,OR PATIENT ON IMMUNOSUPPRESSION THERAPY(RENAL TRANSPLANT),STEROIDS OR CHEMOTHERAPY.
  • 11. RATES OF SURGICAL WOUND INFECTION TYPES OF WOUNDS ACCORDING TO THE RATES OF INFECTION:1- CLEAN WOUND:LIKE HERNIA SURGERY,THYROID, BREAST SURGERY —RATE OF INFECTION 1%-2% .2-CLEAN CONTAMINATED:LIKE CHOLECYSTECTOMY, ORAL CAVITY,GASTRIC SURGERY,BOWEL SURGERY. RATE OF INFECTION LESS THAN 10% .3-CONTAMINATED:APPENDICECTOMY, DIVERTICULITIS RATE OF INFECTION 15%-20%4-DIRTY WOUND: PUS DRAINAGE IN PERFORATEDAPPENDICITIS,APPENDICULAR ABSCESS,APICAL ABSCESS.RATE OF INFECTION IS LESS THAN 40% .
  • 12. SOURCE OF INFECTION1-PRIMARY—ENDOGENOUS FROM THE PATIENT OR COMMUNITY ACQUIRED.2-SECONDARY—HOSPITAL ACQUIRED—NOSOCOMIAL INFECTION-FROM THE THEATRE OR THE WARD.
  • 13. SURGICAL SITE INFECTIONSUPERFICIAL SURGICAL SITE INFECTION: SKIN & SUBCUTANEOUS TISSUE.DEEP SURGICAL SITE INFECTION: MUSCLE & FASCIA.ORGAN OR SPACE SURGICAL SITE INFECTION: ABDOMINAL OR THORACIC (COELOMIC CAVITY).
  • 14. SURGICAL SITE INFECTION (SSI ) SSSI
  • 15. SURGICAL WOUND INFECTIONOTHER CLASSIFICATION OF SURGICAL SITE INFECTION,(SSI) :MINOR INFECTION-SIMPLE INFECTION WITHOUT SIRS.AND PATIENT DISCHARGED HOME.MAJOR INFECTION—INFECTION WITH EXCESS OF PUS,AND WITH SIRS,AND KEEP PATIENT IN THE HOSPITAL,FOR FURTHER TREATMENT.
  • 16. SURGICAL WOUND INFECTION MAJOR WOUND INFECTION-TOO MUCHMINOR WOUND INFECTION—NO,SIRS PUS +SIRS
  • 17. TYPES OF INFECTION1- WOUND ABSCESS.2- CELLULITIS & LYMPHANGITIS.3- BACTERAEMIA & SEPTICAEMIA.4-SPECIFIC WOUND INFECTION :GAS GANGRENE.
  • 18. WOUND ABSCESSIT IS PUS CONTAINING CAVITY .ACUTE ABSCESS: THE WALL OF THE ABSCESS, (CALLED PYOGENIC MEMBRANE);IT IS COMPOSED OF INFLAMMED TISSUE AND FIBRIN ,HEAVILY INFILTERATED BY POLYMORHS ,MACROPHAGE.CHRONIC ABSCESS: WHEN THE WALL COMPOSED OFFIBROUS TISSUE AND HEAVILY INFILTERATED BY,POLY-MORPHS,MACROPHAGE AND OTHER CHRONIC INFLAMMATORY CELLS (LYMPHOCYTES&PLASMA CELLS).
  • 19. SURGICAL WOUND INFECTIONWOUND INFECTION-PUS COLLECTION INFECTION WITH CELLULITIS
  • 20. WHAT IS PUS,AND PUS CELLS?PUS IS A FLUID COMPOSED OF :DEAD &DYING WBC,DEAD &DYING BACTERIA(IN BACTERIAL CAUSE OF PUS),TISSUE DEBRIS,OEDEMA,FIBRIN,LIPID AND NUCLEIC ACID.PUS CELLS :IT IS DEGRANULATED WBC NEUTROPHILS.ACUTE ABSCESS APPEARS 7-9 DAYS AFTER SURGERY ,OR TRAUMA.IF NOT DRAINED IT MIGHT RUPTURE,LEADING TO DISCHARGING SINUS.CHRONIC ABSCESS:IT IS EITHER FROM ACUTE INFECTION AND NOT DRAINED AND PRESENCE OF FOREIGN BODY OR DEAD TISSUE.IT MIGHT BE FROM THE START CHRONIC AS IN T.B. & ACTINOMYCOSIS.
  • 21. MANAGEMENT OF ABSCESSDIAGNOSIS:-CLINICAL: PYREXIA,HIGH PULSE,LEUCO-CYTOSIS.IMAGING TESTS:U/S,CT SCAN &MRI.TREATMENT:DRAINGE UNDER COVER OF ANTIBIOTICS,S.T. ASPIRATION UNDER U/S OR CT GUIDE.NO, CLOSURE OF ABSCESS CAVITY AFTER DRAINAGE,LEAVE IT FOR SPONTANEOUS CLOSURE,OTHER WISE,IT WILL RECURE.
  • 22. SURGICAL WOUND ABSCESSREMOVAL OF STICHES—DRAIN ABSCESS-- FOR DELAYED PRIMARY SUTURING LEAVE IT OPENED OR SECONDARY SUTURING
  • 23. IMAGING TO DIAGNOSE DEEP ABSCESS U/S ABSCESS CAVITY SPLENIC ABSCESS SHOWN BY CT SCAN
  • 24. ASPIRATION OF THE ABSCESS UNDER U/S & CT SCAN
  • 25. DRAINAGE OF ABSCESSDRAINAGE UNDER IMAGING SURGICAL DRAINAGE
  • 26. CELLULITIS,LYMPHANGITISCELLULITIS:DIFFUSE ,NON-LOCALISED NON-SUPPURATATIVE INFLAMMATION CAUSED BY MICRORGANISMSTHAT PRODUCE ,CERTAIN ENZYMES WITH DIFFUSETISSUE DESTRUCTION.THESE ENZMES ARE,STREPTOKINASE ,HYALURONIDASE & OTHER PRO- TEASE ENZYMES,LYSING TISSUE BARRIERS.THE COMMON CAUSATIVE ORGANISM :BETA-HAEMOLYTIC STREPTOCOCCI.CLUSTRIDIA PERFERINGENS.STAPHYLOCOCCI.THIS CELLULITIS ASSOCIATED WITH SIRS,DUE TO RELEASEOF CYTOKINES(INTERLEUKINS,TNF),FROM MACROPHAGE &POLYMORPHS.
  • 27. CELLULITSDIFFUSE NON-LOCALISED INFLAMMATION NON-SUPPURATIVE INFLAMMATION
  • 28. CELLULITISFACIAL CELLULITIS ORBITAL CELLULITIS
  • 29. LYMPHANGITIS IT IS NON-LOCALISED DIFFUSE INFLAMMATION OF LYMPHATIC CHANNELS COMMONLY CAUSED BY STREPTOCOCCUS PYROGENES (BETA HAEMOLYTIC STREPTOCOCCI),PRODUCING RED PAINFUL STREAKSIN THE AFFECTED LYMPHATICS WITH PAINFUL LYMPHNODE ENLARGEMENT.
  • 30. LYMPHANGITISRED PAINFUL STREAKS AXILLARY L.N. ENLARGMENT
  • 31. OTHER FORM OF INFECTION---- BACTERAEMIA,SEPTICAEMIA,PYAEMIADEFINITION:BACTERAEMIA :TRANSIENT PRESENCE OFBACTERIA IN THE BLOOD CIRCULATION CAUSING FEWSYMPTOMS,LIKE RIGOR.THAT WHAT HAPPENS AFTERURINARY BLADDER CATHETERISATION IF SOME INFEC-TION THERE,OR AFTER EXTRACTION OF TOOTH WHICH HAS APICAL ABSCEES.BACTERAEMIA EASILYCONTROLLED BY BODY MPS(MONONUCLEAR PHAGOCYTESYSTEM).PATIENT WITH GOOD IMMUNITY.THE PROBLEM IN THIS CONDITION IS PATIENT WITHC.H.D.,VALVULAR HEART DISEASE,VALVE REPLACEME- NT,JOINT REPLACEMENT,SO BACTERIA WILL SETTLE IN THE HEART PRODUCING SUBACUTE BACTERIAL ENDOC-CARDITIS ,BY STREPTOCOCCI VIRIDANS OR JOINT INFECTION.
  • 32. TYPES OF INFECTION—CONT,DPYAEMIA:INFECTED THROMBUS CIRCULATING IN THE BLOOD,PRODUCING METASTATIC ABSCESS.e.g.;ACUTE APPENDICITIS,INFECTED PILES LEADTO PORTAL PAEMIA LEADING TO METASTATICLIVER ABSCESS.ACUTE SUPPURATIVE ARTHRITIS,OR ACUTEOSTEOMYLITIS MIGHT LEAD TO PYAEMIA WITHMULTIPLE LUNG ABSCESS.
  • 33. CONT,DSEPTICAEMIA:THE ORGANISM PROLIFERATES &BL- OOD FLOODED WITH THE ORGANISM AND THE MPS UNABLE TO DESTROY THEM,SO PATIENT, GRAVELY ILL ,POOR RESISTANCE WITH SEVER CONSTITUTIONAL SYMPTOMES LEADING TO SEPTIC SHOCK AND EVEN TO MSOF(MULTIPLE SYSTEM ORGAN FAILURE ) LEADING TO IRRIVERSIBLE SHOCK AND DEATH.MAIN ORGANISMS INVOLVED IN BOTH BACTERAEMIA & SEPTICAEMIA,GRAM NEGATIVE AEROBIC INTESTINAL BACILLI, (E.COLI,PROTEUS,KLIBSIELA,PSUDOMONAS). STAPHYLOCOCCI,AND FUNGI MIGHT BE INVOLVED.SEPTICAEMIA OCCURS AFTER BOWEL SURGERY,BURNS.
  • 34. WHAT IS THE DIFFERENCE BETWEEN BACTERAEMIA & SEPTICAEMIA ?BACTERAEMIA SEPTICAEMIA
  • 35. OTHER TYPES OF WOUND INFECTIONSPECIFIC WOUND INFECTION; GAS GANGRENE:IT IS INFECTION BY GRAM POSITIVE ANAEROBIC SPORE-FORMING BACILLI,(CL.PERFRINGENS), DUE TO CONTAMINATION OF THE WOUNDS BY FAECES,OR SOILS,COMMONLY SEEN DURING WAR AND TRAUMATIC SURGERY,PARTICULARLY IN ATHEROSCLROSIS LIMBS OR CLOSED DIRTY WOUNDS (ANAEROBIC ENVIROMENT),SO NEVER CLOSE THE WOUND.ALSO DIABETICS,OR IMMUNOCOMPROMISED ARE AT HIGH RISK.AMPUTATED LIMB IN ATHEROSCLEROSIS IS AT RISK. THE CHARACTERISTICS OF THE WOUND IS PAINFUL WITH CREPITUS DUE TO GAS WHICH SEEN BY X-RAY BROWN SWEET SMELLING EXUDATE WITH OEDEMATOUS, SPREADING GANGRENE,PATIENT WITH CIRCULATORY COLLAPSE, SEPTIC SHOCK & MSOF. ACUTE HAEMOLYTIC ANAEMIA DUE TO ALPHA TOXINS. TREATMENT:EXTENSIVE AGGRESSIVE WOUND EXCISION WITH HEAVY DOSE OF PENICILLIN.
  • 36. CLOSTRIDIUM PERFRENGENSGRAM POSITIVE ANAEROBS WITH SPORES SUBTERMINAL SPORES
  • 37. GAS GANGRENEBLISTER WITH GAS FORMING BACTERIA ATHEROSCLEROTIC AMPUTATED LIMB
  • 38. OTHER INFECTION BY CLOSTREDIATETANUS :CAUSED BY CLOSTRIDIA TETANTI,GRAMPOSITIVE ANAEROBIC,SPORFORMING BACILLI,HAVETHE EFFECT DISTANT FROM THE WOUND BY 2EXOTOXINS:TETANOSPASMIN ATTACK CNS,TETANOLYSIN TO HAEMOLYSE RBC .IT CAUSES NEUROLOGICAL DISORDER LIKEOPISTHOTONUS,RISUS SARDONICUS,RESPIRATORYFAILURE IS THE MAIN CAUSE OF DEATH.PROPHYLAXIS :TOXOID VACCINATION,AND GAMMA GLOBULIN THERAPY.
  • 39. CLOSTRIDIUM TETANI-DRUM STICK LIKE BACILLI
  • 40. TETANUSFACIAL & BODY MUSCLE TONIC CONTRACTION RISUS SARDONICUS
  • 41. OPISTHOTONUS-TONIC CONTRACTION OF THE MUSCLES OF THE BACK
  • 42. OTHER INFECTION—SYNERGISTIC SPREADING GANGRENEIT IS AN INFECTION CAUSED BY MIXED ORGANISM ACTING SYNERGISTCALLY,STAPHYLOCOCI,ANAEROBIC STREPTOCOCCI,BACTEROIDS,&COLIFORM,PRODUCI- NG DIFFUSE GANGERNOUS ABDOMINAL WALL, PARTICULARLY AFTER PERITONITIS DRAINAGE, ASSOCIATED WITH CIRCULATORY COLLAPSE,AND EVEN MSOF IT IS ALSO CALLED ,NECROTISING FASC- IT IS ,(MELENY,S SYNERGISTIC GANGRENE ). TREATMENT:CIRCULATORY SUPPORT +WIDE LOCAL EXCISION + ANTIBIOTICS .
  • 43. SYNERGISTIC GANGRENE
  • 44. CONCRUM ORIS—GANGRENOUS STOMATITIS-SYNERGISTIC INFECTION-OPPORTUNISTIC INFECTION-LEUKAMIA
  • 45. A WOUND BECOMES INFECTED OR NOT DEPENDS ON1-VIRULENCE OF THE MICRORGANISM.2-DOSE OF THE MICRORGANISM.3-VASCULARITY OF THE TISSUE INVADED.4-HEALTH OF THE TISSUE INVADED.5-PRESENCE OF DEAD TISSUE OR FOREIGN BODY.6-GENERAL HOST DEFENCE SYSTEM.7-USE OF PROPHYLACTIC ANTIBIOTICS. PROPHYLACTIC ANTIBIOTIC SHOULD BE GIVEN PREO- PERATIVELY OR AT THE TIME OF CUTTING AS THE BACTERIA INVADES THE BODY AND THE HOST NEEDS 4 HOURS (DECISIVE PERIOD) TO DEFEND(HUMORAL &CELLULAR RESISTANCE),SO ANTIBIOTIC SHOULD BE GIVEN AT THE TIME MENTIONED ABOVE.
  • 46. PYOGENIC INFECTION INFECTION BY MICRORGANISM WITH PUS FORMATION OR SUPPURATION. COMMONEST ORGANISMS INVOLVED IN WOUND INFECTION ARE:STAPHYLOCOCCI,STREPTOCOCCI,GRAM NEGATIVE AEROBIC INTESTINAL BACILLI (E.COLI,PROTEUS, KLEBSIELA,PSEUDOMONAS) AND ANAEROBIC GRAM NEGATIVE INTESTINAL BACILLI – BACTEROIDS.WHEN MICRORGANISM INVADES THE WOUND,LEADSTO ACUTE INFLAMMATION---RESOLUTION,IF NOT,SUPPURATION,IF NOT DRAINED –DISCHARGING SINUS.IF NOT RESOLVED ---CHRONIC INFLAMMATION, LIKE CHRONIC CHOLECYSTITIS,CHRONIC OSTEOMYLITIS.
  • 47. GENERAL BODY RESPONSE TO INFECTION--PYREXIA.---RAPID PULSE.---LOSS OF WEIGHT.--- INCREASE OF W.B.C. COUNT.----HIGH ESR.
  • 48. GENERAL TREATMENT OF WOUND INFECTIONIN MINOR WOUND INFECTION,NO,WORRY SENDPATIENT HOME.IN MAJOR WOUND INFECTION WITH PUS COLLECTION:REMOVE THE STICHES,DRAIN THE ABSCESS,SWAB THE PUS,SEND FOR CULTURE & SENSITIVITY TEST FOR AEROBIC &ANAEROBIC MIC- RORGANISM,MEAN WHILE START EMPERICAL ANTIBIOTICS WHILE WAITING FOR THE RESULT OFC&S TEST.IF PATIENT IMPROVING KEEP ON THE ANTIBIOTIC ALREADY STARTED,IF NO,IMPROVEMENT SHIFT TO THE RESULT OF C& S TEST.ANY ABSCESS SHOULD BE DRAINED AND LEFT OPENED,TILL CLEARANCE THEN IF NOT CLOSED SPONTANEOUSLY,DO DELAYED PRIMARY SUTURING(4-6DAYS).OR SECONDARY SUTURING (10-14 DAYS.) .
  • 49. BACTERIA INVOLVED IN WOUND INFECTIONSTREPTOCOCCI:GRAM POSITIVE AEROBIC COCCI.Streptococcus pyogens---CELLULITIS.Streptococcus faecalis---ENTEROCOCCI,INVOLV-ED IN WOUND INFECTION AFTER BOWEL SURGERY.Streptococcus viridans---SUBACUTE BACTERIAL ENDOCARDITIS –AFTER BACTERAEMIA.SENSITIVE TO PENICILLIN & ITS DERIVITIVES.SENSITIVE TO AMPICILLIN, & AMOXOCILLIN.
  • 50. STREPTOCOCCISTREPTOCOCCI—CHAIN COCCI CELLULITIS
  • 51. BACTERIA INVOLVED IN WOUND INFECTION-CONT,DSTAPHYLOCOCCI :GRAM POSITIVE,AEROBIC COCCI.INFORM OF CLUSTERS.COMMONEST CAUSE OF SURGIC-AL WOUND INFECTION PRODUCING LOCALIZED PUSFORMATION.Staphylococcus aureus :COAGULASE POSITIVE, ITMEANS PRODUCING ENZYME TO MAKE THE INFECTI-ON ,MORE LOCALISE BY FIBRIN FORMATION.THESE BACTERIA PRODUCING BETA LACTAMASE ,WHICH DESTROYS THE BETA RING OF PENICILLIN SUB-STANCE.IT IS SENSITIVE TO :FLUCLOXACILLIN,VANCOMYCIN,AMIN-OGLYCOSIDES(GENTAMYCIN),THIRD GENERATION CEPHA-LOSPORINS(CEFATOXIME & CEFATRIOXONE).
  • 52. STAPHYLOCOCCICLUSTERS OF STAPH STAPHYLOCOCCAL WOUND INFECTION
  • 53. WHAT IS MRSA ?IT IS TYPE OF STAPHYLOCOCCI RESISTANCE TO ANTI-BIOTIC METHICILLIN AND HAVE THE ABILITY TO PRODUCE EPIDEMIC INFECTION SPREDING IN THE HOSPITALAND IT IS SENSITIVE TO ANTIBIOTIC VANCOMYCIN. WHAT IS VRSA?IT IS VANCOMYCIN RESISTANT Staphylococcus aureusAGAIN PRODUCING SPREADING HOSPITAL INFECTIONBUT SENSITIVE TO TEICOPLANIN AND LINEOZOLID ANTIBIOTICS.
  • 54. OTHER BACTERIA PRODUCING WOUNDCLOSTREDIA; INFECTIONClostridium perfrengens; GRAM POSITIVE SPORE FORM-ING ANAEROBIC BACILLI CAUSING GAS GANGRENE.PENICILLINE OR METRONIDAZOLE ANTIMICROBIALS.Clostridium tetani:CAUSING TETANUS.Clostridium difficile:CAUSING PSEUDOMEMBRANOUSCOLITIS WITH SEVER DIARRHEA AS ARESULT OF LONGUSAGE OF SPECIAL ANTIBIOTICS LIKE CLINDAMYCIN,& LINCOCIN.TREAMENT VANCOMYCIN,OR METRONIDAZOLE(FLAGYL).
  • 55. GRAM NEGATIVE INTESTINAL BACILLITHESE NORMAL BOWEL INHABITANTS.AEROBIC GROUP:E.COLI,PROTEUS,KLEBSIELA,PSEUDOMONAS.ANAEROBIC GROUP:BACTEROIDS;IT PRODUCES FOUL ODOR PUS,TYPICALANEROBIC INFECTION.AEROBIC+ANAEROBIC=MIXED PRODUCING WOUNDINFECTION AFTER BOWEL SURGERY,LIKE APPENDICECTOMY,DIVERTICULITIS,PERITONITIS.PSEUDOMONAS IS IMPORTANT IN BURN INFECTION,AND SEPTICAEMIA.ALSO INFECTION OF TRACHEOSTOMY.
  • 56. GRAM NEGATIVE INTESTINAL BACILLITHE AEROBIC GROUP SENSITIVE TO THEANTIBIOTICS;AMINOGLYCOSIDES(GENTAMYCIN),SECONDGENERATION CEPHALOSPORINS(CEFAFUROXIME),QUINOLONES (CIPROFLUXACIN). CARABPENEM(MEROPENEM). PSEUDOMONAS:ARE RESISTANT BACTERIA BUTSTILL SENSITIVE TO:AZLOCILLIN,CEFTAZIDIME(THIRD GEN- ERATION CEPHALOSPORINS). TAZOCIN INJECTION: TAZOBACTAM +PIPERACILLIN.
  • 57. SURGICAL WOUND INFECTION AFTER BOWEL SURGERYTHE WOUND OPENED TO DRAIN THE BURST ABDOMEN AFTER BOWEL SURGERY PUS COLLECTION INFECTION
  • 58. BACTERIA INVOLVED IN WOUND INFECTION & ANTIBIOTICS AFFECTING THEM—CONT,DLACTMASE PRODUCING BACTERIA RESISTANCE TOAMOXYCILLIN & AMPICILLIN BUT SENSITIVE TOCOMBINATION OF AMOXYCILLIN +CLAVULANIC ACIDPRODUCING AUGMENTIN WHICH IS VERY EFFECTIVEAGAINST E.COLI,KLEBSIELA,STAPHYLOCOCCI.VERY USEFUL IN BITES WOUNDS (ANIMAL OR HUMAN).BACTEROIDS:VERY SENSITIVE TO METRONIDAZOLE(FLAGYL),THIRD GENERATION CEPHALOSPORIN (CL-AFORAN).MEROPENEM,TAZOCIN.
  • 59. IN INFECTION DUE TO COMBINED MICRO ORGANISMIN COLORECTAL SURGERY,SEVER ORAL CAVITY INFECT-ION,GYNAECOLOGICAL SURGERY.THE ORGANISMS RESPONSIBLE ARE E.COLI,PROTEUS,KLEBSIELA,AND BACTEROIDS SO WE GIVE:GENTAMYCIN+FLAGYL .OR CEFAFUROXIME+FLAGYL.OR MEROPENEM ALONE ,TAZOCIN ALONE OR COMB-INED WITH FLAGYL.QUINOLONES (CLINAFLOXACIN,SITAFLOXACIN).LINCOCIN.