Surgical InfectionSurgical Infection

Dr. Weiguo Hu 胡伟国 Dr. Weihua Qiu 邱伟华Department of Surgery

Rui Jin HospitalShanghai Jiao Tong University School

of Medicine

Definition Classifications Etiology Clinical Manifestation Management Specific Surgical Infections Characteristics of Hand Infections

Key PointsKey Points ：：

Infections be treated by surgical intervention

Infections following surgical procedure (wound or distant site)

DefinitionDefinition ：：

Non-specific infection Furuncle & Carbuncle Cellulitis & Erysipelas Hand infection Acute appendicitis Acute peritonitis Breast abscess

ClassificationsClassifications ：： CharacteristicCharacteristic

Specific infection

Tuberculosis

Fungal infection

Tetanus

Gas gangrene

ClassificationsClassifications ：： CharacteristicCharacteristic

Acute infection (<3w) Most non-specific infection Tetanus Gas gangrene

Chronic infection (>2M) Tuberculosis

Sub-acute infection (3w-2M) Urine tract infection Fungal infection

ClassificationsClassifications ：： Course of Course of Disease Disease

ClassificationsClassifications ：： OthersOthers

Opportunistic Infection

Superinfection

Nosocomial Infection

Local phase

Skin infection

Soft-tissue infection

Hand infection

Abscess

Systemic phase

Bacteremia

Sepsis

ClassificationsClassifications ：： OthersOthers

Bacteria

Virus

Fungi

Endotoxin

Ectotoxin

Enzyme

EtiologyEtiology ：： Pathogenic MicroorgansimPathogenic Microorgansim

Trauma

Ischemia and Hypoxia

Obstruction

Presence of Foreign Bodies and Necrotic Tissues

Ionizing Radiation

Edema

EtiologyEtiology ：： Local FactorsLocal Factors

Severe Trauma

DM

Cancer, Chemotherapy

Leukemia

AIDS

Immunodeficiency

Malnutrition

EtiologyEtiology ：： Systemic FactorsSystemic Factors

Cure

Dissemination

Abscess formation

Bacteriamia & Sepsis

& SIRS & MODS

Chronic infection

ResultsResults ：： Non-specific InfectionsNon-specific Infections

Mixed infection

Tuberculosis Systemic infection

Tetanus, gas gangrene Opportunistic infection

Fungi

ResultsResults ：： Specific InfectionsSpecific Infections

Localized surgical infection

Redness

Swelling

Pain

Heat

Loss of function

Clinical ManifestationClinical Manifestation ：：

Localized surgical infection

Clinical ManifestationClinical Manifestation ：：

Fever

Chills

Tachycardia

Leukocytosis & left shift of WBCs

Synergistic Gangrenecaused by streptococci & staphylococci

(self-injection with heroin)

Severe Systemic Infection (Gram-positive)

Clinical ManifestationClinical Manifestation ：：

Chill, Fever

Flushing

Warm Extremities

Metastatic abscess

Shock in late phase

Severe Systemic Infection (Gram-negative)

Clinical ManifestationClinical Manifestation ：：

Chill, Fever

Cold Extremities

Shock in early phase

Oliguria

High-output heart failure

Disturbed sensorium

DiagnosisDiagnosis ：： HPI

Physical Examination

General Condition

Regional Symptoms

Mal-function of Related Organs

Characteristic Manifestations

DiagnosisDiagnosis ：： Lab Test

CBC

Culture

Sensitivity Test

Others CT

Ultrasonic

X-ray

Intravenous cannula---purulent drainage

or thrombophlebitis

Rectal examination---pelvic abscess

Auscultation of chest---pneumonia

Physical ExamPhysical Exam ：：

Accumulation of extracellular fluid

Color, odor, character Be useful in categorizing the causative organism

Gram stain an essential procedure for diagnosis and treatment

Physical ExamPhysical Exam ： ： ExudateExudate

Breast abscess

Being necessary for diagnosis sometimes

Especially for granulomatous infection

Tuberculosis

blastomycosis

Physical ExamPhysical Exam ： ： BiopsyBiopsy

Exudate the most reliable diagnosis for treatment Both aerobic and anaerobic culture

Blood Diagnostic step for unknown source Fail to capture causative organisms in bacteremia Unnecessary to diagnose sepsis

Sputum Urine

CultureCulture ： ：

ManagementManagement ：： General Supporting

Temperature Control

Management of Water and Electrolytes Balance

Nutrition Supplement

Hypoalbuminemia

Uderlying Factors

Vital Signs Monitor

ManagementManagement ：： Immobilization of the infection area

Effective local care

Relief of swelling & pain

Proper Dressing

Physical Therapy to increase local blood supply to facilitate exudation

ManagementManagement ：： Surgical Therapy

Debridement of Infected or necrotic tissues Harboring foreign objects & microorgnisms

Poor blood supply

Decreasing host resistance

Skin Grafting

Paracentesis

Drainage of Abscess

Removal of Foreign Body

Simple appendicitis treated by early operation

Neglected, perforated appendicitiswith a complex lower abdominal abscessassociated with necrosis of adjacent tissue

Principle of Antibiotics Principle of Antibiotics Management:Management:

Acute sever trauma and infection

Prophylactic Management

Indications:Indications:

Bacteriostatic agents

Prevent growth of bacteria

Bacteriocidal agents

Actually kill bacteria

ManagementManagement ：： AntibioticsAntibiotics

Effective agent against the infecting organism

Adequate contact between agent and organism

Absence of toxic side effect of the agent

Augmentation of host defenses to maximize

antibacterial effects

ManagementManagement ：： AntibioticsAntibiotics

Culture before antibiotic therapy

Administer antibiotics on empiric basis before the laboratory

reports

Culture and sensitivity test (Evidence basis)

a combination of antibiotics for probable polymicrobic infection

ManagementManagement ：： AntibioticsAntibiotics

Colonization The quantitative appearance of changes in the microflora that

are induced by antibiotic therapy

Superinfection A new microbial disease introduced or potentiated by antibiotic

therapy

Superinfection is frequently the result of colonization.

Colonization & Superinfection:Colonization & Superinfection:

for potentially contaminated wounds

Only an adjunct and NOT a substitute to

good surgical technique

Antibiotic ProphylaxisAntibiotic Prophylaxis

Clean procedure no antibiotics are necessary

Clean contaminated procedure Contact of the interior of respiratory, urinary,GI tracts

Contaminated procedure Complicated by gross spillage of intestinal contents or

wounds secondary to trauma Dirty wounds

In contact with intraabdominal or perirectal abscess

Antibiotic ProphylaxisAntibiotic Prophylaxis

Malnourished

Obese

Elderly

Immunodeficient

Shock or MOF

Poor blood supply to the operative region

Antibiotic ProphylaxisAntibiotic Prophylaxis

early and enough for adequate tissue and body

fluid levels

Being necessary to maintain adequate tissue

levels intra-operatively

length of operation and serum half-life of

antibiotics

Antibiotic ProphylaxisAntibiotic Prophylaxis

Cellular site of inhibition Bacteriocidal BacteriostaticCell wall synthesis penicillin

cephalosporins

vancomycin

Barrier function of cell membrane

amphotericin B nystatin

polymyxin

Protein synthesis in ribosome aminoglycosides tetracycline

chloramphenicol

Erythromycin

clindamycin

DNA replication Griseofulvin

Thanks!

Being best treated by operative intervention

Being following surgical procedure

(wound or distant site)

DefinitionDefinition ：：

Superficial wound infection due to hemolytic Streptococci

Localized surgical infection

Clinical ManifestationClinical Manifestation ：：