Surgical Infection Powerpoint based on Scwartz Principlse of Surgery

A presentation on surgical infections would encompass an in-depth examination of infections that occur post-surgery, highlighting their significance in clinical settings. It would cover the various types of surgical infections, such as superficial incisional infections, deep incisional infections, and organ/space infections, delving into their causes, including microbial contamination during surgery, patient-related factors, and procedural factors. The presentation would discuss diagnostic techniques, such as clinical evaluation, laboratory tests, and imaging studies, alongside treatment strategies that include antibiotic therapy, surgical intervention, and supportive care. Additionally, it would emphasize preventive measures, such as stringent aseptic techniques, preoperative skin antisepsis, and postoperative care protocols, to mitigate the incidence of these infections.

1. Surgical Infection
Schwartz’s principle of surgery 10th edition
(chapter 6)

2. Introduction
•Sepsis is both the presence of infection and the host
response to infection (systemic inflammatory response
syndrome, SIRS).
•Sepsis is a clinical spectrum, ranging from sepsis (SIRS
plus infection) to severe sepsis (organ dysfunction), to
septic shock (hypotension requiring vasopressors).
•Outcomes in patients with sepsis are improved with an
organized approach to therapy that includes rapid
resuscitation, antibiotics, and source control.

3. introduction
•Source control is a key concept in the treatment of most
surgically relevant infections.
•Infected or necrotic material must be drained or
removed as part of the treatment plan in this setting.
•Delays inadequate source control are associated with
Worsened outcomes

4. Pathogenesis of Infection
•Host Defenses
skin or subcutaneous tissue are common. The mammalian
host possesses several layers of endogenous defense
mechanisms that serve to prevent microbial invasion, limit
proliferation of microbes within the host , and contain or
eradicate invading microbes.
•Infection is defined by the presence of microorganisms
in host tissue or the bloodstream . At the site of infection
the classic findings of rubor, calor, and dolor in areas such as
the skin or subcutaneous tissue are common

5. Relationship between infection and systemic inflammatory response
syndrome (SIRS).
Sepsis is the presence both of infection and the systemic inflammatory
response, shown here as the intersection of these two areas. Other conditions
may cause SIRS as well (trauma, aspiration, etc.). Severe sepsis (and septic
shock) are both subsets of sepsis.

6. Criteria systemic inflammatory
response syndrome
General variable
•Fever (core temp > 38,3
o
C)
•Hypothermia (core temp < 36
o
C)
•Heart rate > 90 bpm
Altered mental status
•Significant edema or positive fluid balance (>20 mL/kg over 24 h)
•Hyperglycemia in the absence of diabetes
Inflammatory variable
•Leukocytosis (WBC >12,000)
•Leukopenia (WBC <4000)
•Bandemia (>10% band forms)
•Plasma C-reactive protein >2 s.d. above normal value
•Plasma procalcitonin >2 s.d. above normal value

7. Hemodynamic variable
•Arterial hypotension (Systolic Blood Pressure <90 mm Hg, MAP <70, or Systolic Blood
Pressure decrease >40 mmHg)
Organ dysfunction variables
•Arterial hypoxemia
•Acute oliguria
•Creatinine increase
•Coagulation abnormalities
•Ileus
•Thrombocytopenia
•Hyperbilirubinemia
Tissue perfusion variables
•Hyperlactatemia
•Decreased capillary filling
Criteria systemic inflammatory response syndrome

8. Microbiology Of Infectious
Agents
•Bacteria are responsible for the majority of surgical
infections. Specific species are identified using Gram’s
stain and growth characteristics on specific media.
•Bacteria are classified based upon a number of
additional characteristics, including morphology (cocci
and bacilli), the pattern of division (e.g., single
organisms, groups of organisms in pairs [diplococci],
clusters [staphylococci], and chains [streptococci]), and
the presence and location of spores

9. Microbiology Of Infectious
Agents
•Fungi
Fungi typically are identified by use of special stains (e.g.,
potassium hydroxide (KOH), India ink, methenamine silver, or
Giemsa). Initial identification is assisted by observation of the
form of branching and septation in stained specimens or in
culture.
•Viruses
Viral infection was identified by indirect means (i.e., the host
antibody response).

10. Common pathogen in surgical
patient:

11. Surgical Site Infections (SSIs)
•Infections of the tissues, organs, or spaces exposed by
surgeons during performance of an invasive procedure.
•SSIs are classified into incisional and organ/space infections,
and the former are further sub classified into superficial
(limited to skin and subcutaneous tissue) and deep incisional
categories.
•The development of SSIs is related to three factors :
(a) the degree of microbial contamination of the wound during
surgery,
(b) the duration of the procedure, and
(c) host factors such as diabetes, malnutrition, obesity, immune
suppression, and a number of other underlying disease states.

13. Surgical wounds
•Classified based on the presumed magnitude of
the bacterial load at the time of surgery:
•Clean wounds (class I) include those in which no
infection is present; only skin microflora potentially
contaminate the wound, and no hollow viscus that
contains microbes is entered.
•Class I D wounds are similar except that a prosthetic device
(e.g., mesh or valve) is inserted.
•Clean/contaminated wounds (class II) include
those in which a hollow viscus such as the respiratory,
alimentary, or genitourinary tracts with indigenous
bacterial flora is opened under controlled
circumstances without significant spillage of contents.

14. •Contaminated wounds (class III) include open accidental
wounds encountered early after injury, those with extensive
introduction of bacteria into a normally sterile area of the
body due to major breaks in sterile technique (e.g., open
cardiac massage), gross spillage of viscus contents such as
from the intestine, or incision through inflamed, albeit
nonpurulent tissue.
•Dirty wounds (class IV) include traumatic wounds in which
a significant delay in treatment has occurred and in which
necrotic tissue is present, those created in the presence of
overt infection as evidenced by the presence of purulent
material, and those created to access a perforated viscus
accompanied by a high degree of contamination.

16. PREVENTION AND TREATMENT
OF
SURGICAL INFECTIONS
•General Principles
Maneuvers to diminish the presence of exogenous
(surgeon and operating room environment) and
endogenous (patient) microbes are termed prophylaxis,
and consist of the use of mechanical, chemical, and
antimicrobial modalities, or a combination of these
methods.

17. •Source Control
The primary precept of surgical infectious disease therapy consists
of :
•drainage of all purulent material
•debridement of all infected
•devitalized tissue, and debris, or removal of foreign bodies at the
site of infection
•plus remediation of the underlying cause of infection.
PREVENTION AND TREATMENT
OF
SURGICAL INFECTIONS

22. Principles relevant to appropriate
antibiotic prophylaxis for surgery:
•select an agent with activity against organisms
commonly found at the site of surgery
•the initial dose of the antibiotic should be given within
30 minutes prior to the creation of the incision
•the antibiotic should be redosed during long operations
based upon the half-life of the agent to ensure adequate
tissue levels
•the antibiotic regimen should not be continued for more
than 24 hours after surgeryfor routine prophylaxis

23. Principle using antimicrobial agent
for therapy of serious infection:
•identify likely sources of infection
•select an agent (or agents) that will have efficacy against likely
organisms for these sources
•inadequate or delayed antibiotic therapy results in increased
mortality, so it is important to begin therapy rapidly with broader
coverage
•when possible, obtain cultures early and use results to refine therapy
•if no infection is identified after 3 days, strongly consider
discontinuation of antibiotics, based upon the patient’s clinical
course,
•Discontinue antibiotics after an appropriate course of therapy

24. conclusion
•The incidence of surgical site infections can be reduced by:
•appropriate patient preparation
•timely perioperative antibiotic administration
•maintenance of perioperative normothermia and normoglycemia
•appropriate wound management.
•The keys to good outcomes in patients with necrotizing soft
tissue infection are early recognition and appropriate
debridement of infected tissue with repeated
debridement until no further signs of infection are present.

25. THANK YOU