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Surgical%20Infections

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SURGICAL INFECTIONS Under supervision of : Dr. MOHAMMED AL-AKEELY – PowerPoint PPT presentation

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Title: Surgical%20Infections


1
Surgical Infections
  • Under supervision of
  • Dr. MOHAMMED AL-AKEELY

2
infection
  • Invasion of the body by pathogenic microorganisms
    and reaction of the host to organisms and their
    toxins

3
  • A surgical infection is an infection which
    requires surgical treatment and has developed
    befor, or as a complication of surgical treatment.

4
  • could be life threatening
  • Accounts for 1/3 of surgical patients
  • Increased cost to healthcare

5
Some imp defin.
  • Bacteremia bacteria in blood
  • SIRS systemic inflammatory response syndrome
    (fever, tachycardia, tachypnea, leukocytosis)
  • Sepsis documented infection SIRAS
  • Septic shock sepsis hypotension refractory to
    fluid resuscitation

6
Principles of surgical treatment
  • Debridement- necrotic, injured, dead tissue
  • Drainage- abscess, infected fluid
  • Removal- infection source, foreign body
  • Supportive measures
  • immobilization
  • elevation
  • antibiotics

7
Common organisms
  • Gram positive bacteria
  • Streptococci
  • Staphylococci
  • Clostridia
  • Gram negative bacteria
  • Pseudomonas
  • E. coli
  • Bacteroid fragilis

8
Streptococcal infections
  1. Cellulitis
  2. Lymphangitis
  3. Lymphadenitis
  4. Necrotizing faciitis

9
cellulitis
  • severe inflammation of dermal and subcutaneous
    layers of the skin.
  • caused by normal skin flora(group A strept
    /staph)or by exogenous bacteria.
  • the bacteria can spread rapidly, entering the
    lymph nodes and the bloodstream and spreading
    throughout the body.
  • In rare cases, the infection can spread to the
    deep layer of tissue (Necrotizing faciitis).
  • often occurs in broken skin.

10
cellulitis
  • Signs symptoms affected area is red, hot, and
    tender with vague borders.
  • Most common sites Face, hand and lower
    extremities.
  • RF old age immunodeficiency.
  • Diagnosis clinically.
  • TX
  • 1- resting, elevation of the affected limb,
    debridement.
  • 2- ampicillin/amoxicillin in moderate (suspected
    strept) flucloxacillin or dicloxacillin for
    mild (staph)

11
cellulitis
12
Erysipelas
  • Erysipelas is the term used for a more
    superficial infection of the dermis and upper
    subcutaneous layer that presents clinically with
    raised surface and well defined edge.
  • Erysipelas and cellulitis often coexist, so it is
    often difficult to make a distinction between the
    two.

13
Erysipelas
14
Lymphangitis
  • Lymphangitis is an inflammation of the lymphatic
    channels that occurs as a result of infection at
    a site distal to the channel.
  • Streptococcus pyogenes.
  • Signs and symptoms deep reddening of the skin,
    warmth, with moderate pain and swelling.
    Lymphadenitis, chills and a high fever along. (
    appears as red streak).

15
Lymphangitis
  • Tx
  • 1-elevate and immobilize affected areas to reduce
    swelling, pain, and the spread of infection.
  • 2- antibiotic.

16
Lymphangitis
17
LYMPHADENITIS
  • Lymphadenitis is an infection of the lymph nodes.
  • Lymphadenitis may occur after skin infections or
    other bacterial infections, particularly those
    due to streptococcus or staphylococcus.
  • Swollen, tender, or hard lymph nodes
  • Red, tender skin over lymph node
  • Lymph nodes may feel rubbery if an abscess has
    formed.

18
LYMPHADENITIS
  • Treatment may include
  • Antibiotics to treat any underlying infection
  • Analgesics (pain killers) to control pain
  • Anti-inflammatory medications to reduce
    inflammation and swelling
  • Cool compresses to reduce inflammation and pain
  • Surgery may be needed to drain any abscess.

19
LYMPHADENITIS
20
Necrotizing fasciitis (flesh-eating disease)
  • Infection and necrosis of the deeper layers of
    skin and subcutaneous tissues.
  • 2 types lpolymicrobial
  • ll monomicrobial (mostly group
    A strept)
  • Signs and symptoms The infection begins locally,
    at a site of traumagtgtintense paingtgt then tissue
    becomes swollen (hrs.)
  • Common sites abdominal wall, perineum, and
    limbs.
  • Diagnosis visual examination microscopic
    evaluation of tissue samples.

21
Necrotizing fasciitis
  • RF diabetes, abdominal surgery, drug addict and
    trauma.
  • Tx
  • 1-Early medical treatment (combination of
    intravenous antibiotics including penicillin,
    vancomycin, and clindamycin)
  • 2-Cultures are taken to determine appropriate
    antibiotic
  • 3-aggressive surgical debridement ( no
    definitive boundries!!)
  • High mortality rate (75) if left untreated.

22
Necrotizing fasciitis
23
Staphylococcal Infections
  • Abscess is a collection of pus (dead
    neutrophils) that has accumulated in a cavity
    formed by the tissue
  • It is a defensive reaction of the tissue to
    prevent the spread of infectious materials to
    other parts of the body
  • As Staphylococcus aureus bacteria is a common
    cause, an anti-staphylococcus antibiotic such as
    flucloxacillin or dicloxacillin is used
  • Incision and drainage is a common surgical
    intervention in case of abscess

24
Staphylococcal Infections
  • Furuncle- infection of one hair follicle /
    sweat glands
  • Carbuncle- extension of furuncle into subcut.
    Tissue with possible formation of abscess.
  • usually more than one furuncle
  • common in diabetic patient
  • common sites- back, back of neck
  • Treatment drainage, antibiotics, control
    diabetes

25
Staphylococcal Infections
26
Clostridial infections
  • Gas gangrene
  • Tetanus
  • Pseudomembranous colitis

27
GAS GANGRENE
  • is a bacterial infection that produces gas in
    gangrenous tissues usually caused by Clostridium
    perfrengins bacteria.
  • It is a medical emergency (Progression to
    toxemia and shock is often very rapid)
  • Large wounds contaminated by soil.
  • It results in rapid myonecrosis, swelling,
    seropurulent discharge, foul smelling wound,
    crepitus in subcutaneous tissue.

28
GAS GANGRENE
  • X-ray gas in muscle and under skin.
  • Tx
  • 1-Wound exposure, debridement , drainage.
  • 2-Penicillin, clindamycin, metronidazole
  • 3-Hyperbaric oxygen chamber

29
GAS GANGRENE
30
TETANUS
  • Cl. Tetani, produce neurotoxin
  • Penetrating wound ( rusty nail, thorn )
  • Incubation period 7-10 days
  • Usually wound healed when symptoms appear
  • Trismus- first symptom, stiffness in neck back
  • Anxious look with mouth drawn up ( risus
    sardonicus)
  • Progressive dysphasia, dysphagia, dyspnea tonic
    convulsion
  • Death by exhaustion, aspiration or asphyxiation

31
TETANUS
  • Treatment
  • wound debridement
  • Muscle relaxants, penicillin
  • ventilatory support
  • Prophylaxis
  • vaccination by HTIG T toxoid in tetanus prone
    wound in patient with unknown or incomplete
    history of immunization.
  • If it is more than 5 years since last dose of
    tetanus immunization give only T toxoid.

32
PSEUDOMEMBRANOUS COLITIS
  • Superinfection in patients in long term oral
    antibiotic therapy
  • Cl. Difficile
  • Watery diarrhea, abdominal pain, fever
  • Diagnosis needs Sigmoidoscopy, stool- culture and
    toxin assay
  • Treatment
  • stop offending antibiotic
  • oral vancomycin/
    metronidazole
  • rehydration, isolate patient

33
Pseudomonas
  • Opportunestic bacteria that may cause surface
    infections, but may also cause serious and lethal
    infection.
  • Enter the body through minor skin abrasion,
    ventilator tubes, urinary catheters and IV lines
    gtgtgt therefore it is common in ICU.
  • Can cause septecimia (particularly in burn
    wounds)
  • Tx aminoglycosides, piperacillin, ceftazidine.

34
E. coli
  • Normal intestinal flora, facultative anearobes.
  • May cause circulatory collapse (due to
    endotoxin), wound infections, meningitis,
    endocarditis, abdominal abscess UTI.
  • Tx ampicillin, aminoglycosides, cephalosporine.

35
Bacteroides fragilis
  • Normal flora of mouth and colon, anearobic.
  • Produce foul smelling pus, gas in surrounding
    tissues necrosis.
  • Responsible for intraabdominal gyne. infection.
  • Causes spiking fever, jaundice leukocytosis.
  • Tx
  • Surgical drainage, excision.
  • Clindamycin, metronidazole.

36
Hospital aquired infections
  • The most common is UTI
  • The most common causing death is pneumonia.

37
Surgical site infection (SSI)
  • 38 of all surgical infections
  • Infection within 30 days of operation
  • Classification
  • Superficial Superficial SSIinfection in
    subcutaneous plane (47)
  • Deep Subfascial SSI- muscle plane (23)
  • Organ/ space SSI- intra-abdominal,
    other spaces (30)
  • Staph. aureus- most common organism
  • E coli, Entercoccus ,other Entetobacteriaceae-
    deep infections
  • B fragilis intrabd. abscess

38
Surgical site infection (SSI)
  • Risk factors age, malnutrition, obesity,
    immunocompromised, poor surg. tech, prolonged
    surgery, preop. shaving and type of surgery.
  • Diagnosis
  • Sup.SSI- erythema, oedema, discharge and pain
  • Deep infections- no local signs, fever, pain,
    hypotension. need
    investigations.
  • Treatment surgical / radiological intervention.

39
Surgical site infection (SSI)
  • Intra-abdominal infections
  • Generalized
  • Localized
  • Prevention- good tech., avoid bowel injury, good
    anastomosis.
  • Diagnosis- History, exam., investigations CT
    scan.
  • Treatment- surgery/ intervention
  • Antibiotics (aerobe
    anaerobe)

40
UTI
  • UTI are usually consequences of foley cathetar.
  • The most common symptoms of a bladder infection
    are burning with urination (dysuria), frequency
    of urination and an urge to urinate.
  • may also present with flank pain and a fever.

41
UTI
  • Diagnostic test
  • -urinalysis (nitrate, estrase)
  • -culture
  • -urine microscopy (WBCgt10)
  • The common org. is
  • - E. coli, klebsiella, enterococcus
    staph. aureus

42
TREATMENT
  • Ab.with gram (-) spectrum
  • -sulphamethoxasole
  • -trimethoprim
  • -gentamycin
  • -ceprofloxacin
  • Check culture sensitivity

43
pneumonia
  • Rout of infection
  • -gross aspiration during anesthesia
  • or intubation. Pathogen includes
  • anaerobic organism gram(-)
  • bacilli.
  • - Atelectasis the collapsed lung may become
    secondarily infected
  • -contiguous spread from another site.

44
pneumonia
  • Sing symptoms
  • People with pneumonia often have one or more of
    these symptoms Fever, productive cough,
    shortness of breath, hypoxia and chest pain.
  • Chest x-ray sputum culture are important to
    confirm the diagnose.

45
treatment
  • Hospital acquired pneumonia generally treated by
    cefuroxime, ceftriaxone for the usual pathogen(
    gram(-), s.aureus , strept.pn, H. influenzae)
    treatment of other pathogen.
  • if there is recent Hx of abd.surg the infectious
    org. is anaerobes we should add clindamycin

46
  • If the pt. is comatose or has head trauma, DM, or
    renal failure the org. usually is s.aureus
    there is risk of MRSA we add vancomycin
  • If the pt. take high dose of glucocorticoides the
    org. usually is legionella we add
    macrolide (azithromycin)

47
  • If the pt. has malnutrition, structural lung
    disease, glucocorticoid therapy the org. usually
    is pseudomonas.a
  • Also if the pt. has Hx of neuro.surg. ,head
    trauma, ARDS, aspiration the org. usually is
    acinetobacter spp.
  • All of them treated by the standard treatment
    aminoglycoside or ciprofloxacin IV
    antipseudomonal penicillin or imipenem.

48
Sterilization and Disinfection
  • Sterilization means ERADICATING all
    microorganisms and SPORES.
  • Disinfection means the eradication of vegetative
    form only leaving SPORES.
  • For sterilization, autoclave is the most common
    instrument used.
  • Antiseptic is used on the surface of the body
    like alcohol, chlorohexidine
  • Disinfectent is applied on metals and other
    instruments like formaldehyde formalin
  • Plastic materials are best sterilized using
    chemicals while metalic instrument can be safely
    sterilized in the autoclave.

49
antibiotics
  • Chemotherapeutic agents that act on organisms
  • Bacteriocidal Penicillin,Cephalosporin,
    Vancomycin, Aminoglycosides
  • Bacteriostatic Erythromycin,Clindamycin,Tetracycl
    ine

50
COMMON ANTIBIOTICS
  • Penicillins- penicillin G
  • Cephalosporins (II, III)-Cefruoxime, Ceftriaxone
  • Aminoglycosides- Gentamycin
  • Fluoroquinolones- Ciprofloxacin
  • Glycopeptides- Vancomycin
  • Macrolides- Erythromycin,
  • Tetracyclines-, Doxycycline

51
Prophylactic ab.
  • Prophylaxis in clean-contaminated or high risk
    clean wounds.
  • Antibiotic is given just before patient sent for
    surgery.
  • Duration of antibiotic is controversial (one
    dose-or more , should not be used more than 24
    hour regimen )

52
Wound Classification
53
  • Thank u
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