Soft tissue infection

1. Soft tissue infections
Done by :
Abdulhadi T. Gelaidan
Supervised by ;
Dr.Majed Mansouri

2. Content of lecture:
• Antibiotics use

3. Content of lecture:
• Antibiotics use
• Relation between infection and
body.

4. Content of lecture:
• Antibiotics use
• Relation between infection and
body.
• Important bacteria in General
surgery.

5. Content of lecture:
• Antibiotics use
• Relation between infection and
body.
• Important bacteria in General
surgery.
• Important antibiotics in G.S.

6. Content of lecture:
• Antibiotics use
• Relation between infection and
body.
• Important bacteria in General
surgery.
• Important antibiotics in G.S.
• Types of soft tissue infections

7. Antibiotics use
• Prophylaxis :
indications
- Increase in risk of infect.
-Wound classes.
-Infection = Disaster
e.g : infected heart valve

8. What are the risk of infection?

9. • Wound classes
• Immune deficiency
• Medications steroids
• Chronic illness
• Nutritions
• Old Age
What are the risk of infection?

10. Wound classifications

11. Wound classifications
• Clean wounds

12. Wound classifications
• Clean wounds
• Clean-contaminated

13. Wound classifications
• Clean wounds
• Clean-contaminated
• Contaminated

14. Wound classifications
• Clean wounds
• Clean-contaminated
• Contaminated
• Dirty

15. Risk of infection
• Wound classes
• Immune deficiency
• Medications steroids
• Chronic illness
• Nutritions
• Old Age

16. Risk of infection
1-Host :
-Diet – vit.C .
-Extreme age.
-Chronic illness.
-D.M, CLD, CRF
-Medications: Steroid
-Impaired immunity: HIV
2-Infection agent :
3-Battle ground wound :
-Ischemia
-Necrosis
-Gangreneous
-Decrease WBC ,Abs
-Virulence
-Numbers

17. 1-Host :
-Diet – vit.C .
-Extreme age.
-Chronic illness.
-D.M, CLD, CRF
-Medications: Steroid
-Impaired immunity: HIV
Risk of infection
2-Infection agent :
3-Battle ground wound :
-Ischemia
-Necrosis
-Gangreneous
-Decrease WBC ,Abs
-Virulence
-Numbers

18. Risk of infection
1-Host :
-Diet – vit.C .
-Extreme age.
-Chronic illness.
-D.M, CLD, CRF
-Medications: Steroid
-Impaired immunity: HIV
2-Infection agent :
3-Battle ground wound :
-Ischemia
-Necrosis
-Gangreneous
-Decrease WBC ,Abs
-Virulence
-Numbers

19. Risk of infection
1-Host :
-Diet – vit.C .
-Extreme age.
-Chronic illness.
-D.M, CLD, CRF
-Medications: Steroid
-Impaired immunity: HIV
2-Infection agent :
3-Battle ground wound :
-Ischemia
-Necrosis
-Gangreneous
-Decrease WBC ,Abs
-Virulence
-Numbers

20. Important Bacteria in G.S
COCCi BACILLI
Gram + ve :
Gram – ve :
Gram + ve :
Gram – ve :

21. Important Bacteria in G.S
COCCi BACILLI
Gram + ve :
Gram – ve :
Gram + ve :
Gram – ve :
Gram + ve :
- Stapylococci
-Streptcocci
-Enterococcus
-Peptostreptococcus

22. Important Bacteria in G.S
COCCi BACILLI
Gram + ve : Gram + ve :
Gram – ve :
Gram + ve :
- Stapylococci
-Streptcocci
-Enterococcus
-Peptostreptococcus
Gram – ve :
-Acinetobacter
-Moraxella
-Neisseria

23. Important Bacteria in G.S
COCCi BACILLI
Gram + ve :
Gram – ve :
Gram + ve :
- Stapylococci
-Streptcocci
-Enterococcus
-Peptostreptococcus
Gram – ve :
-Acinetobacter
-Moraxella
-Neisseria
Gram + ve :
-bacillus
-clostridium
-corynebacterium
-lactobacillus
-Listeria
-Propinobacterium

24. Important Bacteria in G.S
COCCi BACILLI
Gram + ve :
- Stapylococci
-Streptcocci
-Enterococcus
-Peptostreptococcus
Gram – ve :
-Acinetobacter
-Moraxella
-Neisseria
Gram – ve :
-Pseudomonas
-E.coli
-Shigella
-Salmonella
-Klebsilla
-Bacteroids
-Helicobacter
-Campylobactur
-Fusobacterium
-Proteus
-Prevottella
-Providencia
-Serratia
-Vibrio
-Yersinia
-Bartonella
-Bordetella
-Brucella
-Francisella
-Hemophilus
-Legionella
-Pasteurella
Gram + ve :
-bacillus
-clostridium
-corynebacterium
-lactobacillus
-Listeria
-Propinobacterium

25. Important Bacteria in G.S
G+ve Anaerobic
- Clostridium tetani
- Clostridium perfringes
- Clostridium defficuili
- Clostridium botulinium
-Bacteroides
-Fusobacterium
-Prevotella
G-ve Anaerobic

26. Common antibiotics
Macrolides
Others
-Combined
Tazocine
Tazopactum
Bactrim
Septrin
Fluoroquinolones carmabenum
Aminoglycosides
Cephalosporine
Penecillin
Antibiotics

27. Penecillins
• Bacteria coverage : Gram (+) Cocci,
C.perfringens.
• Used in: cellulites & carbuncle
Synthetic &
combined

28. But what are the problem with
PENECILLINS ?

29. But what are the problem with
PENECILLINS ?
• Limited spectrum

30. But what are the problem with
PENECILLINS ?
• Limited spectrum
• Resistance

31. Cephalosporine
Action: cell wall inhibitors.
Cephalosporines
1st generation
2nd gene.
PC-TRX
3rd gene.
Any cef. Out of
PC-TRX
4th gene.
Cefazoline
Cephalexin
cefadroxil
Cefprozil PO
Cefaclor
Cefotetan
Cefuroxime I.M-I.V
Cefoxitin
Ceftazidime which
Pass through
BBB
Cefepime
Mainly
Gram +
G-,G+,Anaerobic
Mainly Gram - G-,Anaerobic
Pseudomonus,
Anaerobic

32. Aminoglycosides
• Bacteria coverage : G (+)cocci & G ( - )bacilli
• Sub group : Gentamicin, Tobramycin ,Amikacin
,Neomycin ,Streptomycin
• Execreted by: kidney
• Side effects: Renal toxicity and Ototoxicity

33. Nalidixic acid,Ciprofloxacine, Norfloxacin,
Ofloxacin ,Moxifloxacin ,Levofloxacin
• G(- ve)
• Most active against pseudomonas
Subtypes: Azithromycine, Erythromycine ,
Clarithromycin ,Telithromycin
Bacteria coverage : G (+)cocci & G ( - )bacilli
Macrolides
Fluoroquinolones

34. Bacteria coverage : Broad spectrum
Subtypes: merupenum - imipenem
Contra indication: panceriatitis-seizure – not
allowed to given by doctors less than R5
Carbapenems

35. Clindamycine
Bacteria coverage: Anaerobic & G +ve cocci

36. Vancomycine
• Bacteria coverage : MRSA,G + ve.
• Used in: prosthetic valve ,dialysis catheter

37. Augmantin
combination antibiotic containing amoxicillin trihydrate, a β-
lactam antibiotic, with potassium clavulanate, a β-
lactamase inhibitor. This combination results in an
antibiotic with an increased spectrum of action and
restored efficacy against amoxicillin-resistant bacteria
that produce β-lactamase.

38. Bactrim (septrin)
• combination of trimethoprim and
sulfamethoxazole

39. Tazocin
• Piperacillin is an extended spectrum beta-lactam
antibiotic of the ureidopenicillin class.
• It is normally used together with a beta-lactamase
inhibitor such as tazobactam. The combination drug of
piperacillin and tazobactam
• Its main uses are in intensive care medicine (pneumonia,
peritonitis), some diabetes-related foot infections and
empirical therapy in febrile neutropenia (e.g. after
chemotherapy).

40. Soft tissue infections
Superficial (skin and subcutanous) :-
-Boils
-Folliculitis
-Impetigo
-Erysipelas
-Cellulitis
-Abcess
-Carbuncle
Deep ( Fascia & Muscle) :-
-Necrotizing Fasciitis
-Gas gangrene
Organs :-
-Cholecystitis
-Appendicitis

41. Soft tissue infections

42. Superficial (skin and
subcutanous)
1- Boils :
it is infection of single hair follicle
2- Folliculitis
Folliculitis is a infection of group of hair
follicles;

43. Impetigo
3- Impetigo :
staphylococcus , streptoccus infection
which presented with honey crust skin
after blisters rupture.
Rx : by direct washing, topical Abcs , oral
Abcs

44. Erysipelas
4 –(localized cellulitis) sharply demarcated
streptcoccal infection of lymphatic vessels,
usually associated with broken skin on
face, erythema, Oedema
do --- C/S
Rx : broad spectrum Abcs

45. 5-Cellulitis
- Is a diffuse inflammation of connective tissue
with severe inflammation of dermal and
subcutaneous layers of the skin. Cellulitis can
be caused by normal skin flora or by
exogenous bacteria, and often occurs where
the skin has previously been broken.

46. 6-Skin Abcess
- Is a collection of pus (dead neutrophils) that has
accumulated in a cavity formed by the tissue in which the
pus resides on the basis of an infectious process (usually
caused by bacteria or parasites)

47. 7-Carbuncle
- Is an abscess larger than a
boil, usually with one or more
openings draining pus onto the
skin.

48. Deep ( Muscle & Fascia)
1- Necrotizing fasciitis :
Flesh-eating disease or Flesh-eating bacteria syndrome, is
a infection of the deeper layers of skin and
subcutaneous tissues, easily spreading across the
fascial plane within the subcutaneous tissue

49. 2 – Gas gangrene : is a bacterial infection that
produces gas tissues in gangrene. It is a deadly form of
gangrene usually caused by anaerobic bacteria. It is a
medical emergency.
Deep ( Muscle & Fascia)

51. Deep organs
- Appendicitis.
- Acute cholecystitis