A brief presentation on common surgical infections. Includes skin and soft tissue infections. Abscess, gas gangrene.

1. Management of
Infections
Explore the fundamental principles of antimicrobial therapy and understand
how it plays a critical role in treating infectious diseases.
By Dr Immad ud din
Postgraduate Urology resident

2. Pus ‫چرک‬
Necrosis ‫مرگ‬
Polymicrobial ‫چندمیکروبی‬
Etiology ‫شناسی‬ ‫سبب‬
Broad spectrum antibiotics
‫گسترده‬ ‫طیف‬ ‫های‬‫بیوتیک‬‫آنتی‬
Edema ‫ورم‬
Crepitus ‫خشخشی‬
Chronic ‫دیرینه‬

3. Infections can be managed by medications and when indicated by surgery
Medical management:
• Pain Killers
• Anti-inflammatory drugs
• Antibiotics
Surgical management:
• Incision & drainage
• Wound debridement
• Wound wash
• Amputations

4. Antimicrobial Drug Selection
Selecting the right antimicrobial drugs is crucial for effective treatment. Factors such as the type of infection,
infection, microbial susceptibility, and patient factors should be considered.
• “Best guess policy” based on experience of that particular condition, likely organism and most likely sensitivity
likely sensitivity to drugs.
Infection
exists
Appropriate
specimen
for C/S
Start with
Emperic
antibiotic
Clinical response
assessment
Change Antibiotic
based on C/S
A suitable duration of antimicrobial therapy should be for 5-10 days

5. Infections Primarily Treated by
Surgical Management
In some cases, surgical intervention is necessary to treat certain types of
infections. These infections include abscesses, necrotizing fasciitis, and gas
gangrene.

6. Skin Infections
1 Boil
A painful, pus-filled infection that forms in
in a hair follicle or oil gland.
2
Carbuncle
Similar to a boil but larger and may have
have multiple openings. It often occurs in
occurs in areas with thicker skin, such as
as the back of the neck or thighs.
3 Cellulitis
A bacterial infection that affects the
deeper layers of the skin, causing redness,
redness, swelling, and warmth.
Staphylococcus Aureus is the most common organism

7. Abscess:
It is a localized collection of pus containing neutrophils, dead tissues and organisms surrounded
By membrane that can develop anywhere in the body.
Commonestpathogen is staphylococcus aureus
Close to the skin
• Abscessesclose to the skin
are often painful, red, hot
and raised.
• They may cause systemic
upset
• They are diagnosed
clinically
Deeper abscess:
• Deeper abscesses may present
with swinging pyrexia,
leukocytosis, systemic upset and
pressure symptoms.
• They are diagnosed using
Ultrasound or CT scanning.
Rx: I & D

8. Suppurative Infections
Ludwig's Angina
A severe infection that
affects the floor of the
mouth, causing swelling
and difficulty breathing.
Hidradenitis
Suppurativa
A chronic skin condition
characterized by painful,
recurrent abscesses in
areas near sweat glands,
such as the armpits or
groin.
Paronychia
An infection that occurs
occurs around the nails,
nails, often caused by
bacteria or fungi.
Ingrowing Toe
Nail
A condition where the
edge of a toenail grows
into the surrounding skin,
skin, causing pain, redness,
redness, and swelling.

9. Necrotizing faciitis
It is the infection of skin and subcutaneous tissue leading to necrosis. The muscles
are spared (differentiates it from myonecrosis)
▪ Type 1: Polymicrobial etiology, also known as synergistic bacterial gangrene.
Fournier’s gangrene is a special type affecting the perineal area and
Meleney’s gangrene is a special type affecting the abdominal wall.
▪ Type 2: Single organism infection caused by Beta hemolytic group A
streptococcus.
Minor trauma >> Bacterial exotoxins & enzymes >> necrosis of fat and fascia and
skin
Presents as severe wound pain, signs of spreading inflammation, crepitus and
smell. It can lead to systemic sepsis and multiorgan failure.
Rx: Urgent surgical debridement of all necrotic tissue + review surgery. Broad
spectrum antibiotics

10. Gas Gangrene
Also called clostridial gangrene. It is caused by Clostridium perfringens, a spore
forming anaerobic bacterium.
• It is normally found in soil and faeces and introduced into human body
during trauma. Military wound, missile wounds soiled with dirt and
surrounding devascularised tissue provides the ideal environment.
• It involves the skeletal muscles hence named clostridial myonecrosis.
• Produces exotoxin that leads to rapidly spreading muscle necrosis with
overlying skin discoloration, edema and crepitus.
Rx:
• Urgent surgical excision of all necrotic tissue and high dose antibiotics (Benzyl
penicillin + Meteronidazole.
• Amputation may be needed

11. Madura Foot (Mycetoma)
• A chronic bacterial or fungal infection that affects the foot, typically
characterized by swollen and discharging sinuses.
• It involves the subcutaeous tissue after traumatic inoculation.
1. Eumycetoma: It is caused by true fungi (P boydii)
2. Actinomycetoma:Caused by higher bacteria
Common in areas where barefoot walking is common.
Earliest sign is painless subcutaneous swelling which gradually
develops multiple sinuses and get secondarily infected.
Rx: First define the etiology (Fungal or bacterial)
• Antibiotics works well for Actinomycetoma
• Antifungals are used for Eumycetoma
Surgery is recommended for localized lesions that can be excised
completely.

12. Summary
1 Select Wisely
Choosing the right
antimicrobial drugs based
on individual patient
factors and microbial
susceptibility is essential
for successful treatment.
2 ConsiderSurgical
Management
Certain infections, like
abscesses and necrotizing
necrotizing fasciitis, may
may require surgical
intervention to promote
promote healing.
3 Be Mindful of Skin
Infections
Recognizing and treating
treating skin infections,
such as boils and cellulitis,
cellulitis, is crucial to
prevent complications and
and promote recovery.

13. References
Source 1
General surgery by Dr Abdul
Wahab dogar
Source 2
Baliey & Love short practice
of surgery