Infection Environment• Wound or a natural space with narrow outlets• Fluids, foreign bodies, a closed unperfused space etc
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
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
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
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
OPERATIVE WOUNDS• NATIONAL RESEARCH COUNCIL CLASSIFICATION OF OPERATIVE WOUNDS
CLASSIFICATION OF OPERATIVE WOUNDS• CLEAN• • Nontraumatic• • No inflammation encountered• • No break in technique• • Respiratory, alimentary, genitourinary tracts not entered
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
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
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.
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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