Successfully reported this slideshow.

Surgical infections


Published on

Surgical Infections

Published in: Health & Medicine, Business

Surgical infections

  2. 2. SURGICAL INFECTIONS• Infections that require surgical treatment or• related to operative interventions
  3. 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. 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. 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. 6. PATHOGENESIS• DETERMINANTS OF INFECTIONS• Microorganism• Host Defenses (virulance) (type&severity of immunosupression)• INFECTION Environment• (Fluids, foreign bodies, a closed unperfused space etc.)
  7. 7. 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
  8. 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. 9. HOST DEFENSE MECHANISMS• Nonspecific• Surface Mechanical barrier• (skin, mucosa) Secretory barrier Immunoglobulins• Ciliary motion Movement
  10. 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. 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. 12. A Susceptible host• Iatrogenic• • Antineoplastic• chemotherapy• • Immunosuppressive• therapy• (allograft recipients,• autoimmune disorders)• • Splenectomy
  13. 13. Infection Environment• Wound or a natural space with narrow outlets• Fluids, foreign bodies, a closed unperfused space etc
  14. 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. 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. 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. 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. 18. Diagnosis• • Redness• • Swelling• • Hyperthermia• • Fluctuation• • Purulent or turbid aspirate
  20. 20. CLASSIFICATION OF OPERATIVE WOUNDS• CLEAN• • Nontraumatic• • No inflammation encountered• • No break in technique• • Respiratory, alimentary, genitourinary tracts not entered
  21. 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. 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. 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. 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