Surgical Infections

1. SURGICAL INFECTIONS

2. SURGICAL INFECTIONS
• Infections that require surgical treatment or
• related to operative interventions

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. 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. 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. PATHOGENESIS
• DETERMINANTS OF INFECTIONS
• Microorganism
• Host Defenses
(virulance) (type&severity of
immunosupression)
• INFECTION Environment
• (Fluids, foreign bodies, a closed unperfused
space etc.)

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. 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. HOST DEFENSE MECHANISMS
• Nonspecific
• Surface Mechanical barrier
• (skin, mucosa) Secretory barrier
Immunoglobulins
• Ciliary motion Movement

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. 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. A Susceptible host
• Iatrogenic
• • Antineoplastic
• chemotherapy
• • Immunosuppressive
• therapy
• (allograft recipients,
• autoimmune disorders)
• • Splenectomy

13. Infection Environment
• Wound or a natural space with narrow
outlets
• Fluids, foreign bodies, a closed unperfused
space etc

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. 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. 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. 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. Diagnosis
• • Redness
• • Swelling
• • Hyperthermia
• • Fluctuation
• • Purulent or turbid aspirate

19. OPERATIVE WOUNDS
• NATIONAL RESEARCH COUNCIL
CLASSIFICATION OF OPERATIVE WOUNDS

20. CLASSIFICATION OF OPERATIVE WOUNDS
• CLEAN
• • Nontraumatic
• • No inflammation encountered
• • No break in technique
• • Respiratory, alimentary, genitourinary tracts
not entered

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. 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. 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. 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