SURGICAL INFECTIONS Begashaw - PowerPoint Presentation

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SURGICAL INFECTIONS

Begashaw

M (MD)

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Surgical infection

D

efined as an

infection related to or complicating a surgical therapy and requiring surgical management

Related to surgical therapy but may not require surgery

- UTI after catheterization

Pulmonary CXN after intubation

Tracheotomy site infection

Post-operative wound infection

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CLASSIFICATION

P

re operative infections

:

before a surgical procedure

- Accidents

- Appendicitis

- Boils

- Carbuncle

-

Pyomyositis

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Operative infections

Happen during a surgical procedure

D

ue

to -

contamination of the site

-poor tissue handling

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Postoperative infections

Occur

after

a surgical procedure

Contamination is from the

patient’s

source

e.g

- Surgical wound infections

- Urinary & respiratory tract infection

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PATHOGENESIS

E

lements or factors include:

- An infectious

agent

- A susceptible

host

- Favorable external factors/

environment

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Infectious agents

1- Aerobic bacteria

- Staphylococcus

aureus

- Streptococci

-

Klebsiella

- E. coli

2- Anaerobic bacteria

-

Bacteroides

-

Peptostreptococci

- Clostridia

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Infectious agents

3- Fungi

-

Histoplasma

- Candida

-

Nocardia

and

actinomycetes

4

-

Parasites

-

Entameba

hystolytica

-amebic liver abscess

-

Echinococcus

-

hydatid

cyst

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Host Susceptibility

Reduced immunity/host defense

-D

iabetes mellitus

-TB

-AIDS

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Local and external factors

Local

factors

- Poor

vascularization

- Poor perfusion of blood and oxygen

- Dead tissue

- F

oreign bodies

- Closure under tension

External factors

-break in the sterility technique

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Clinical manifestation

H

otness, redness, edema/swelling,

pain & loss of function

Non-Specific symptoms- Fever, chills, tachycardia

Constitutional

symptoms

- Fatigue,

low

-grade

fever

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Investigations

WBC count: usually elevated

Gram stain

,

culture & sensitivity

Blood culture:

bacterermia

Biopsy:

Histologic

X-ray and ultrasound

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Post-Operative Wound Infection

I

s contamination of a surgical wound during or after a surgical procedure

I

s usually confined superficial

B

elow the fascia

-

deep infection

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Types

of

Surgical Site Infections

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Source of infection

80% cases - patient (Endogenous)

-skin ,transected

viscus

. In about

20% cases - Exogenous

-environment

-operating staff

-unsterile surgical equipment

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Clinical Findings

O

n the 5th-7

th

postoperative

day

- Fever

- Wound pain

- Wound edema and

induration

- Local hotness and tenderness

- Wound/stitch abscess

- Serous discharge

-

Crepitation

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Wound infection

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Management

- Remove stitches to allow drainage

- Local wound care

- Antibiotics-if systemic manifestations/

cellulitis

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Prevention

Shorten

preop

. Hospitalization

Loose weight

Treatment of remote infection

Shorten

operative time

Restore host

defense

Decrease endogenous bacterial

cont.

Good surgical technique

Proper asepsis and antisepsis

Chemoprophylaxis

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Abscess

L

ocalized collection of pus

C

ontains necrotic tissue

&

suppuration

Etiology

-

Pyogenic

organisms - staphylococci

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Abscess

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Clinical features

- Superficial (Hot, pain, edema, redness

and loss of function)

- Fluctuation

- Discharge & sinus

- Systemic - fever, sweating, tachycardia

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Treatment

- Drainage by

incision

- Debridement & curettage

- Delayed primary or secondary closure

- Antibiotics - systemic symptoms or signs of spread occur-

cloxacillin

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Abcsess drainage

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Abscess drainage

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Erysipelas

_ Acute skin infection that is more superficial than

cellulitis

_ Etiology

- Group A Streptococcus (GABHS)

_Clinical Features

Intense

erythema

,

induration

, & sharply demarcated borders

_Treatment - penicillin or first generation cephalosporin -

cephalexin

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Eryspelas

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Cellulitis

Non-

suppurative

infection of skin and subcutaneous tissues

U

sually involves the extremities

I

dentifiable portal of entry

Etiology: skin flora

- Beta hemolytic streptococci

- Staphylococci

- Clostridium

perfringens

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Clinical Features

Source of infection

-trauma, recent surgery

-diabetes - cracked skin

-foreign bodies

Systemic - fever, chills, malaise

Pain, tenderness, edema,

erythema

with poorly defined margins

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cellulitis

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Cellulitis

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Investigation

CBC, blood cultures

Culture and Gram stain

Plain radiographs- R/o

osteomyelitis

Cellulitis

Vs

Eryspela

-

Cellulitis

:

indistinct

border

-

Erysipela

:

sharp

boarder

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Management

- Rest

- Elevation/immobilize

- Hot, wet pack

- High dose broad spectrum antibiotics IV

_

Cloxacillin

500 mg QID/

cephalexin

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Pyomyositis

A

cute bacterial infection of skeletal muscles with accumulation of pus in

the intramuscular area

O

ccurs in the lower limbs &

trunk

Associated factors-Poor

nutrition

-

immune deficiency

-

hot climate

-

intense muscle activity

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Etiology

-Staphylococcus

aureus

- common

-Streptococci

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Clinical Features

S

ub-acute onset

•

L

ocalized muscle pain & swelling

T

enderness

•

Induration

,

erythema

,

heat

•

Muscle necrosis

•

Fever

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Pyomyositis

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Treatment

•

I

ntravenous antibiotics-

cloxacillin

•

S

urgical drainage

•

E

xcision

-

necrotic muscle

•

S

upportive care-analgesics

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Necrotizing fasciitis

Rapidly spreading

,

very painful

infection of the deep fascia with necrosis of tissues

Some bacteria create gas that can be felt as

crepitus

Infection spreads rapidly along deep

fascial

plane and is limb and life threatening

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Etiology

Polymicrobial

- Streptococci- hemolytic

- Staphylococci

- Gram negative bacteria

- Anaerobes

- Clostridia

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Clinical Features

Pain out of proportion

Erythema

, edema, tenderness, ±

crepitus

±fever

Infection spreads very rapidly

Rapidly become very sick/toxic

Skin turns dusky blue and black (secondary to thrombosis & necrosis)

Induration

, formation of

bullae

Cutaneous

gangrene, subcutaneous emphysema

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Necrotizing fascitis

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Treatment

Rigorous resuscitation

Multiple surgical debridement: remove all necrotic tissue, copious irrigation

IV antibiotics-

Ceftriaxone

+

Metronidazole

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Gas Gangrene

Characterized by muscle necrosis and systemic toxicity

Follows - Trauma

- Surgery

- Foreign bodies

- Vascular insufficiency

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Etiology

-

Clostridium

perfringens

-80% of cases

-

polymicrobial

infection

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Clinical features

- Sudden and persistent severe pain at wound site

- Localized tense edema, pallor , tenderness

- Gas noted on palpation or radiograph

- brownish discoloration of skin and hemorrhagic

bullae

- Dirty brown discharge with offensive, sweetish odor

- Systemic - fever,

tachycardia,hypotension

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Gas on soft tissue

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Management

Surgery

- important

-Extensive, wide excision

-Amputation

-Antibiotic

-Supportive

- Intravenous infusions

- Blood transfusions

- Close monitoring

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TETANUS

Cl.

Tetani

, produce neurotoxin

Penetrating wound

( rusty nail, thorn )

Usually wound healed when symptoms appear

Incubation period: 7-10 days

Trismus

- first symptom, stiffness in neck & back

Anxious look with mouth drawn up

(

risus

sardonicus

)

Respiration & swallowing progressively difficult

Reflex convulsions along with tonic spasm

Death by exhaustion, aspiration or asphyxiation

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TETANUS

Treatment:

wound debridement, penicillin

Muscle relaxants,

ventilatory

support

Nutritional support

Prophylaxis:

wound care, antibiotics

Human TIG in high risk ( un-immunized )

Commence active immunization ( T

toxoid

)

Previously immunized-

booster >10 years needs a booster dose

booster <10 years- no treatment in low risk wounds

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