Terima kasih atas masukannya. Saya akan mempelajari lebih lanjut tentang topik ini agar dapat memberikan penjelasan yang lebih lengkap dan akurat ke depannya.

1. Regi Septian

2. Introduction
 Infection  Identification of microorganisms in host
tissue or the blood stream, and an inflammatory
response to their presence.
 Pathogenesis  mechanism of infection and to the
mechanism by which disease develops.

4. Host Defenses
 Host possesses several layers of endogenous defense
mechanism  prevent microbial invasion, limit
proliferation of microbes within the host, and contain
or eradicate invading microbes.
 Skin  physical barrier.
 Mucus + cilia  trapping and clearing respiratory tract
 Gastric acid  kills bacteria
 Macrophages, complements, immunoglobulin 
inflammatory response activation

5. Host Defenses
 The magnitude of the response and eventual outcome
generally are related to several factors:
 (a) the initial number of microbes
 (b) the rate of microbial proliferation in relation to
containment and killing by host defenses
 (c) microbial virulence
 (d) the potency of host defenses.
 drugs or disease states that diminish any or multiple components
of host defenses are associated with higher rates and potentially more
grave infections.

6. Etiology
 Bacteria, Fungi, Virus
Bacteria:
 Major etiology of surgical infections.
 Gram (+)  aerobic skin commensals (Staphylococcus
aureus and epidermidis and Streptococcus pyogenes) and
enteric organisms such as E. faecalis and faecium
 Aerobic skin commensals cause a large percentage of
surgical site infections
 Enterococci can cause nosocomial infections [urinary tract
infections (UTIs) and bacteremia] in
immunocompromised or chronically ill patients, but are of
relatively low virulence in healthy individuals

7. Bacteria
 Gram (-)  E. coli, Klebsiella pneumoniae, Serratia
marcescens, and Enterobacter, Citrobacter, and
Acinetobacter spp.
 Anaerobic organism  unable to grow or divide poorly
in air, as most do not possess the enzyme catalase,
which allows for metabolism of reactive oxygen
species.

8. Fungi
 Fungi of relevance to surgeons include those that
cause nosocomial infections in surgical patients as
part of polymicrobial infections or fungemia (e.g., C.
albicans and related species), rare causes of aggressive
soft tissue infections (e.g., Mucor, Rhizopus, and
Absidia spp.), and so-called opportunistic pathogens
that cause infection in the immunocompromised host
(e.g., Aspergillus fumigatus, niger, terreus, and other
spp., Blastomyces dermatitidis, Coccidioides immitis,
and Cryptococcus neoformans).

9. Virus
 Most viral infections in surgical patients occur in the
immunocompromised host, particularly those
receiving immunosuppression to prevent rejection of a
solid organ allograft.
 Relevant viruses include
adenoviruses, cytomegalovirus, Epstein-Barr
virus, herpes simplex virus, and varicella-zoster virus.
 Surgeons must be aware of the manifestations of
hepatitis B and C virus, as well as HIV
infections, including their capacity to be transmitted
to health care workers

10. Nosocomial Infection
 Infections that are acquired in hospital (48 hours or
more after admission)
 SSI (Surgical Site Infection)
 UTI (Urinary Tract Infection)
 Pneumonia
 Bacteremia

11. SSI (Surgical Site Infection)
 Infections of the tissues, organs, or spaces exposed by
surgeons during performance of an invasive procedure
 Classification :
 Incisional Infections
- Superficial
- Deep
 Organ/Space infections

12. Factors related to SSI develoment :
 The degree of microbial contamination
 The duration of the procedure
 Host factors (diabetes, malnutrition, obesity, etc.)

13. UTI (Urinary Tract Infection)
 Prolonged use of folley catheter for purpose of urinary
drainage
 Culture results : > 104 CFU/mL of microbes
 Postoperative surgical patients should have urinary
catheters removed as quickly as possible, typically
within 1 to 2 days, as long as they are mobile.

14. Hospital Acquired Pneumonia
 Prolonged use of ventilation tubes
 Diagnosis should be made using the presence of a
purulent sputum, elevated leukocyte count, fever, and
new chest x-ray abnormality
 Surgical patients should be weaned from mechanical
ventilation as soon as feasible, based on oxygenation
and inspiratory effort.

15. Bacteremia
 Prolonged use of venous or arterial access
 Many patients who develop intravascular catheter
infections are asymptomatic, often exhibiting an
elevation in the blood WBC count.
 Routine, scheduled catheter changes are associated
with slightly lower rates of infection

16. 4 Important Factors
 The host
 The microbes
 The environment
 Treatment

17. The Host
 People in hospital are already sick
 Poor general resistance to infection
 Lack of immunity  age, immunocompromised
 Reduced immunity  diabetes, severe burns
 Poor local resistance  poor blood supply to tissues
 Surgery  wound, sutures
 Medical devices  catheters, prostheses, tubing

18. The Microbes
 Nosocomial infections are often caused by
opportunistic pathogens those which do not normally
cause infection in healthy people
 May be a reflection of reduced defences of host or
access to sites not normally colonised by organisms
 May be from normal flora or environment

19. Opportunistic Pathogens
 Pseudomonas aeruginosa
 Staphylococci
 E. coli and other coliforms
 Streptococci and Enterococci
 Bacteriodes fragilis
 Candida albicans
 Herpes simplex virus
 Cytomegalovirus

20. The Environment
 Own normal flora (endogenous)
 Infected patients
 Traffic of staff and visitors
 Blood products
 Surgical instruments

21. Prevention and Treatment
 Prophylaxis  Maneuvers to diminish the presence of
exogenous (surgeon and operating room environment)
and endogenous (patient) microbes
General Principles:
 Minimalize microflora entering the surgical site:
 Gloves, gown
 Aseptic and antiseptic
 Hair removal before the procedure

22. Source Control
 The primary precept of surgical infectious disease therapy
consists of drainage of all purulent material, débridement
of all infected, devitalized tissue, and debris, and/or
removal of foreign bodies at the site of infection, plus
remediation of the underlying cause of infection
 An ongoing source of contamination (e.g., bowel
perforation) or the presence of an aggressive, rapidly-
spreading infection (e.g., necrotizing soft tissue infection)
invariably requires expedient, aggressive operative
intervention, both to remove contaminated material and
infected tissue (e.g., radical débridement or amputation)
and to remove the initial cause of infection (e.g., bowel
resection).

23. 5 Pillars of Infection Control
 Isolation and barrier precautions
 Decontamination of equipment
 Prudent use of antibiotics
 Hand washing
 Decontamination of environment

24. Thank You

25.  Harap menambahkan tentang agent infeksi: flora
normal, penghasil toksin, etc
 Perbedaan kolonisasi dan infeksi
 Infeksi jamur: dermatophyte? Saprophyte? Mukor?