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Surgical infections
 

Surgical infections

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Surgical Infections

Surgical Infections

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    Surgical infections Surgical infections Presentation Transcript

    • SURGICAL INFECTIONS
    • SURGICAL INFECTIONS• Infections that require surgical treatment or• related to operative interventions
    • 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
    • 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)
    • 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
    • PATHOGENESIS• DETERMINANTS OF INFECTIONS• Microorganism• Host Defenses (virulance) (type&severity of immunosupression)• INFECTION Environment• (Fluids, foreign bodies, a closed unperfused space etc.)
    • Infectious agent• The Endogenous Gastrointestinal Microflora• • Stomach• • Duodenum Aerobes and anaerobes• • Proximal small bowel <104/mL• • Distal small bowel Enterobacteriaceae Enterococcus spp 103-108/mL Anaerobic organisms• • Colon Anaerobic organisms Bacteriodes fragilis 1012/mL
    • 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
    • HOST DEFENSE MECHANISMS• Nonspecific• Surface Mechanical barrier• (skin, mucosa) Secretory barrier Immunoglobulins• Ciliary motion Movement
    • 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
    • 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
    • A Susceptible host• Iatrogenic• • Antineoplastic• chemotherapy• • Immunosuppressive• therapy• (allograft recipients,• autoimmune disorders)• • Splenectomy
    • 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
    • Diagnosis• • Redness• • Swelling• • Hyperthermia• • Fluctuation• • Purulent or turbid aspirate
    • 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