Anaerobic Infection Surgery..pptxiiiiuyu

Ytyuyyy

1. Kyrgyz Russian Slavic University Bishkek 2024 Department of General and Faculty Surgery Name – Pushkar.Pandurang.Karad Group- 7 th (3 rd Course) Professor – Sherov.Ruslan.Rasulzhanovich ( Md,PhD in Surgery,Surgeon,Associate Professor) Subject – General Surgery Topic 10 – Anaerobic infection. Specific surgical infection. Page No.1

2. Index Introduction to Anaerobic Infections Characteristics of Anaerobic Bacteria Common Anaerobic Pathogens Risk Factors for Anaerobic Infections Clinical Features of Anaerobic Infections Diagnosis (Surgical Relevance) Common Surgical Anaerobic Infections Management Principles Surgical Intervention Techniques Antibiotic Therapy Post-operative Care and Complications Prevention Strategies Summary References Page No.2

3. 1] Introduction - Anaerobic infections are infections caused by organisms that do not require oxygen for growth.
They are often polymicrobial and involve synergistic aerobic-anaerobic interaction.
Anaerobes are part of normal flora but become pathogenic when mucosal barriers are disrupted.
In surgical infections, anaerobes contribute significantly to morbidity and mortality.
Early identification and aggressive management are crucial to prevent devastating outcomes.
Delay in diagnosis may result in systemic sepsis and multiorgan failure.. Page No.3 https://accessmedicine.mhmedical.com/book.aspx?bookid=3095

4. Anaerobes are implicated in 20–30% of surgical site infections (SSIs).
Commonly seen in abdominal, gynecological, head and neck, and soft tissue infections.
Anaerobic infections often involve deep tissue layers, making surgical drainage essential.
Infections may manifest after trauma, ischemia, surgery, or malignancy-related necrosis.
They require specific anaerobic cultures for microbiological diagnosis, which is often missed.
Understanding anaerobes is critical for better antimicrobial stewardship in surgical settings. Importance in Surgery Page No.4 https://www.uptodate.com

5. Definition Anaerobic infections are infections caused by bacteria that thrive in the absence of oxygen. Specific surgical infections refer to those infections that are closely associated with surgical interventions or trauma. Anaerobic organisms flourish in devitalized tissue and closed spaces, often resulting in rapidly progressive infections requiring urgent intervention. Page No.5 https://en.m.wikipedia.org/wiki/Surgery https://www.shutterstock.com/image-vector/blood-loss-icon-vector-illustration-2313011165

6. Characteristics of Anaerobes Inability to grow in presence of oxygen. Gas production (crepitus) often present. Often polymicrobial with aerobes. Foul-smelling discharge is typical. Produces tissue-destructive enzymes. Page No.6

7. Common Anaerobic Pathogens Bacteroides fragilis group: intra-abdominal infections.
Clostridium perfringens : gas gangrene. Peptostreptococcus species: soft tissue infections. Fusobacterium species: head and neck infections. Prevotella species: oral infections. Page No.6 https://accessmedicine.mhmedical.com/book.aspx?bookid=3095

8. Natural Habitat Normal flora of:
Oral cavity
Gastrointestinal tract
Genitourinary tract
Skin folds
Infection occurs when barriers are disrupted. Page No.8 https://www.who.int/publications/i/item/9789241550370

9. Pathogenesis Injury or surgery leads to oxygen-poor environment. Aerobes consume oxygen → facilitates anaerobe growth. Anaerobes produce toxins, enzymes causing necrosis. Rapid tissue destruction and systemic sepsis. Page No.9 shttps :// www.who.int /publications/ i /item/9789241550370

10. Risk Factors Trauma with soil contamination. Gastrointestinal or gynecological surgeries. Diabetes mellitus, immunosuppression. Peripheral vascular disease. Presence of foreign bodies like implants. Figure 1: Diabetic foot, ischemic with necrosis Figure 2: Necrotic diabetic foot Figure 3: Ischemic disease, necrotic wound tissue Page No.10 https://www.fitnessgenes.com/blog/trait-118-lowering-risk-of-blood-clots

11. Diagnostic Approach High clinical suspicion essential. Early imaging: CT/MRI for deep infections. Specimen collection under anaerobic conditions. Gram stain: mixed flora common. Cultures and molecular tests confirm diagnosis. Page No.11 https://my.clevelandclinic.org/health/diseases/anaerobic

12. Clinical Features - General Local signs: severe pain, erythema, swelling, warmth. Systemic signs: fever, tachycardia, hypotension. Foul-smelling pus or discharge. Rapid progression and systemic toxicity. Page No.12 https://www.elsevier.com/books/sabiston-textbook-of-surgery/townsend/978-0-323-66182-7

13. Clinical Features - Specific Crepitus (gas in tissue). Skin discoloration (dusky, blackish). Severe disproportionate pain. Rapid spread along fascial planes. Multiorgan dysfunction in severe cases. Page No.13 https://my.clevelandclinic.org/health/diseases/anaerobicbacteria https://www.shutterstock.com/image-vector/blood-loss-icon-vector-illustration-2313011165

14. Imaging Plain X-ray: gas in soft tissues.
Ultrasound: abscess identification.
CT scan: detects fluid collections, gas pockets, extent of infection.
MRI: excellent for soft tissue and fascial plane evaluation. Page No.14

15. Sample Collection Aspirated pus preferred over swabs.
Use anaerobic transport media.
Avoid superficial wound swabs.
Early sample collection before antibiotic therapy started. Page No.15 https://my.clevelandclinic.org/health/diseases/hemorrhage

16. General Treatment Principles Surgical debridement of necrotic tissue. Drainage of abscesses. Broad-spectrum antibiotic therapy. Supportive care: fluid resuscitation, organ support. Page No.16 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582

17. Antibiotic Therapy Empirical coverage against anaerobes: Metronidazole Clindamycin Carbapenems Beta-lactam + beta-lactamase inhibitors (e.g., piperacillin-tazobactam ). Tailor antibiotics based on sensitivity. Page No.17 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582

18. Surgical Management Wide Excision of Necrotic Tissue: Remove all necrotic tissue to halt toxin production. Early Debridement: Vital to prevent anaerobic growth and to reduce systemic toxicity. Repeated Debridements : In severe cases, multiple debridements are necessary. Negative Pressure Wound Therapy (VAC): Effective in removing exudates and promoting tissue granulation. Page No.18 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582

19. Continued Page No.19 https://www.shutterstock.com/image-vector/blood-loss-icon-vector-illustration-2313011165 Fasciotomy : In cases of necrotizing fasciitis to release pressure from infected tissue.
Amputation: Considered in severe cases like gas gangrene or extensive necrosis in limbs.
Drainage of Abscesses: Ensures adequate fluid outflow from deep infections.
Follow-up Imaging: Monitor for recurrence of infection or abscess formation.

20. Specific Anaerobic Infections in Surgery
Gas Gangrene ( Clostridial Myonecrosis ) Etiology: Caused by Clostridium perfringens , Clostridium septicum , or Clostridium novyi .
Clinical Features: Rapid onset of pain, swelling, crepitus, and systemic shock.
Pathophysiology: Release of alpha-toxin leading to muscle necrosis, hemolysis, and systemic toxicity.
Management: Early debridement, high-dose intravenous penicillin, and hyperbaric oxygen therapy.
Prognosis: Mortality rates can be high if not managed early. Page No.20 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582

21. Specific Anaerobic Infections in Surgery
Necrotizing Fasciitis Etiology: Caused by a mixed infection, including anaerobes like Clostridium, Bacteroides , and Fusobacterium .
Clinical Features: Severe pain out of proportion to the physical exam, fever, erythema, and expanding tissue necrosis.
Management: Immediate broad-spectrum antibiotics, surgical debridement, and possibly fasciotomy .
Prognosis: Mortality depends on the extent of tissue involvement, time to treatment, and comorbid conditions. Page No.21 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582

22. Specific Anaerobic Infections in Surgery
Intra-abdominal Abscesses Etiology: Bacteroides fragilis , Clostridium perfringens , Peptostreptococcus species.
Clinical Features: Abdominal pain, fever, and localized tenderness.
Management: Drainage of abscesses combined with anaerobic coverage antibiotics.
Prognosis: Excellent with early intervention; delayed treatment may lead to sepsis and multiorgan failure. Page No.22 Guyton and Hall Textbook of Medical Physiology (13th Edition)Chapter 36: "Hemostasis and Blood Coagulation" (Page No. 447–455)

23. Specific Anaerobic Infections in Surgery
Diabetic Foot Infections Etiology: Polymicrobial , with Bacteroides , Clostridium, and Fusobacterium species.
Clinical Features: Erythema, swelling, pus, and gangrene in foot wounds, especially in patients with poor circulation.
Management: Surgical debridement, wound care, glycemic control, and appropriate antibiotic therapy.
Prognosis: Good with early intervention, but poor healing can occur in severe cases due to vascular compromise. Page No.23 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582

24. Specific Anaerobic Infections in Surgery
Deep Neck Space Infections Page No.24 https://www.routledge.com/Bailey--Loves-Short-Practice-of-Surgery-28th-Edition/Williams-Bulstrode-OConnell/p/book/9780367331582 Etiology: Fusobacterium necrophorum , Prevotella , and Bacteroides species.
Clinical Features: Severe neck pain, swelling, fever, difficulty swallowing, and respiratory distress.
Management: Surgical drainage, broad-spectrum antibiotics, and airway management.
Prognosis: Mortality rates are lower with prompt surgical drainage and antibiotics.

25. Clostridium difficile and Surgery Page No.25 https://en.m.wikipedia.org/wiki/Clostridium Etiology: Clostridium difficile is a common anaerobic pathogen in surgical patients, especially those who have recently received antibiotics.
Clinical Manifestations: Watery diarrhea, fever, abdominal cramping, and pseudomembranous colitis.
Diagnosis: Stool culture, PCR for toxin genes, and endoscopy to visualize pseudomembranes .
Management:
Antibiotic therapy: Metronidazole or oral vancomycin .
Fecal microbiota transplantation (FMT): For recurrent infections.
Surgical intervention: Colectomy in severe cases with toxic megacolon or perforation.

26. Anaerobic Infections in the Head and Neck Region Common Pathogens: Fusobacterium necrophorum , Peptostreptococcus , Bacteroides Risk Factors: Dental procedures, head and neck trauma, and poor oral hygiene., Immunocompromised states. Clinical Features: Severe pain, swelling, and abscess formation in deep neck spaces. Difficulty swallowing and breathing due to airway compromise. Management: Surgical drainage of abscesses or collections. Antibiotics targeting anaerobes, such as penicillin plus metronidazole or clindamycin. Close monitoring for airway compromise and sepsis. Page No.26

27. Anaerobic Infections in the Pelvis and Perineum Common Pathogens Bacteroides fragilis Clostridium species Fusobacterium Clinical Features:
Abdominal pain, fever, and distension.
Rectal or vaginal discharge in cases of pelvic abscesses.
Perineal or genital swelling, erythema, and crepitus
Management:
Drainage of pelvic abscesses via percutaneous or surgical means.
Antibiotic therapy targeting anaerobes.
Supportive care, including fluid resuscitation and pain management. Page No.27

28. Anaerobic Infections in Immunocompromised Patients Page No.28 https://en.m.wikipedia.org/wiki/Anaerobicinf Increased Risk Factors:
Chemotherapy
Organ transplantation
Diabetes mellitus
HIV/AIDS
Long-term corticosteroid use
Common Pathogens in Immunocompromised Patients: Bacteroides fragilis Clostridium difficile (especially in patients with antibiotic exposure) Fusobacterium Management:
Early recognition and aggressive debridement are critical.
Broader antibiotic coverage, considering polymicrobial infections, should be used.
Close monitoring for sepsis and multi-organ failure.

29. Prevention of Anaerobic Infections Preoperative Antibiotic Prophylaxis: Broad-spectrum antibiotics for high-risk surgeries (e.g., gastrointestinal, gynecological, or soft tissue surgeries). Proper Wound Care: Adequate cleansing and debridement of wounds. Avoiding Ischemia: Timely intervention to restore blood flow to compromised tissues. Control of Diabetes: Maintain optimal glucose control to reduce the risk of infection. Tetanus Prophylaxis: In cases of trauma involving soil or contaminated objects. Page No.29

30. Prevention of Anaerobic Infections Minimize Foreign Bodies: Removal of non-essential foreign bodies (e.g., catheters, drains) as soon as possible. Surgical Technique: Use of meticulous surgical techniques to prevent contamination during surgery. Oxygenation: Ensure adequate oxygenation during surgery to reduce anaerobic environments. Enhanced Recovery Programs: Postoperative care strategies to optimize healing and reduce the risk of wound infection. Page No.30

31. Prognosis and Complications Gas Gangrene: Mortality rate is very high (>50%) in untreated cases. Early treatment with antibiotics and debridement improves prognosis. Necrotizing Fasciitis: Mortality rates can exceed 30% despite treatment, especially in immunocompromised patients. Intra-abdominal Abscesses: Mortality rates are lower with timely intervention, but recurrence can occur. Diabetic Foot Infections: Poor prognosis if infection progresses to osteomyelitis or gangrene. Early surgical debridement improves outcomes. Page No.31

32. Recent Advances and Future Directions Next-Generation Sequencing (NGS): A faster and more accurate method for identifying anaerobic pathogens. Advanced Imaging Techniques: Newer techniques such as PET-CT are helping with better localization and diagnosis. Improved Antibiotics: Development of newer antibiotics targeting anaerobic infections, including drugs that overcome resistance. Immunotherapy and Vaccines: Potential for adjuvant therapies targeting specific anaerobic pathogens, especially for Clostridium and Bacteroides species. Page No 32

33. Summary Anaerobic infections are a significant concern in surgical practice due to their aggressive nature and rapid progression.
Prompt diagnosis, early surgical intervention, and appropriate antimicrobial therapy are critical for successful outcomes.
The importance of a multidisciplinary approach in managing severe anaerobic infections cannot be overstated.
With improved diagnostics, antimicrobial agents, and surgical techniques, prognosis has greatly improved, although severe cases still carry high mortality. Page No.33

34. Anaerobic Infections and Post-Surgical Wound Infections Risk Factors for Post-Surgical Infections: Contaminated surgical site, Poor nutritional status , Immunosuppression , Diabetes , Vascular insufficiency Common Pathogens: Clostridium species , Bacteroides ragil , Fusobacterium , Peptostreptococcus Management Strategies: Early identification of infection symptoms such as fever, erythema, and increasing pain. Immediate culture and sensitivity testing. Early surgical intervention, including debridement and drainage, as well as appropriate antibiotic therapy. Page No.34 Tintinalli’s Emergency Medicine: A Comprehensive Study Guide Page No.145-201

35. Differential Diagnosis of Anaerobic Infections Necrotizing Fasciitis vs. Cellulitis: Necrotizing fasciitis presents with severe pain and systemic toxicity, whereas cellulitis typically has less severe systemic involvement and more localized findings. Surgical exploration is often required to differentiate the two. Abscess Formation vs. Simple Inflammation: Abscesses show fluctuant swelling, warmth, and purulent drainage, whereas simple inflammation may show erythema and mild edema without pus. Gas Gangrene vs. Hematoma or Soft Tissue Injury: Gas gangrene presents with rapid-onset muscle pain, crepitus, and systemic signs of shock. A CT or MRI may reveal extensive soft tissue gas. Page no.35 Tintinalli’s Emergency Medicine: A Comprehensive Study Guide Page No.145-201

36. Role of Imaging in Diagnosis X-rays: Detect gas in tissues, especially in cases of gas gangrene. Ultrasound: Useful for detecting abscesses and soft tissue collections. CT Scan: Provides detailed visualization of deep space infections, abscesses, and gas in tissues. MRI: Excellent for identifying soft tissue infections and assessing the extent of necrosis or abscess formation in deep tissues. Positron Emission Tomography (PET-CT): In certain cases, PET-CT can help identify anaerobic infection sites and assess metabolic activity. Page No.36 Tintinalli’s Emergency Medicine: A Comprehensive Study Guide Page No.145-201

37. Special Considerations in Surgical Management of Anaerobic Infections Role of Adjunctive Therapies: Hyperbaric oxygen therapy (HBOT) for severe gas gangrene and necrotizing infections. Antitoxin therapy may be necessary for Clostridium tetani and Clostridium botulinum infections. Prophylactic measures, including tetanus vaccination in cases of contaminated wounds. Multidisciplinary Approach: Collaboration between surgeons, infectious disease specialists, and intensivists is vital for complex cases. Ongoing assessment for the potential need for further debridement or surgical intervention. Page No.37 Tintinalli’s Emergency Medicine: A Comprehensive Study Guide Page No.145-201

38. Conclusion Anaerobic infections are often aggressive and require prompt surgical intervention, antibiotic therapy, and multidisciplinary care.
The rapid identification of the infection type, appropriate debridement, and tailored antibiotic treatment are critical factors for reducing mortality.
Advances in imaging, antibiotic therapy, and adjunctive treatments like hyperbaric oxygen therapy offer improved outcomes for complex anaerobic infections.
Early diagnosis and appropriate management can significantly reduce morbidity and mortality rates associated with anaerobic infections in surgical settings. Page No.38 https://www.elsevier.com/books/sabiston-textbook-of-surgery/townsend/978-0-323-66182-7

39. Refrences 1) Sabiston Textbook of Surgery, 21 st Edition
Chapter: Surgical Infections — Anaerobic infections and management principles.
2)Schwartz’s Principles of Surgery, 11 th Edition
Chapter: Infection — especially sections discussing anaerobic bacteria in surgical infections.
3) Bailey & Love’s Short Practice of Surgery, 28 th Edition
Chapter: Infections — including wound infections and anaerobes.
4) Harrison’s Principles of Internal Medicine, 21 st Edition
Chapter: Anaerobic infections — Microbiology, clinical presentation, and antibiotic therapy.
5) CDC Guidelines (Centers for Disease Control and Prevention)
Healthcare-associated infections: Prevention and management strategies.

40. Thank You….