SURGICAL INFECTIONS

Gastrointestinal surgical department

of affiliated hospital of jining medical
college
SURGICAL INFECTIONS

 Infections that require surgical

treatment or
 related to operative
interventions
SURGICAL INFECTIONS
 Infections required surgical
treatment
 • Necrotizing soft tissue infections
 • Infections of body cavities
(peritonitis, empyema, etc.)
 • Infections confined to an organ or
tissue (abscesses, septic arthritis,
cholecystitis, etc)
 • Prosthetic device infections
SURGICAL INFECTIONS
 INFECTIONS RELATED TO
OPERATIVE INTERVENTION
 • Wound infections - Surgical site

infections
 • Postoperative infections

(peritonitis or other cavity

infections)
 • Surgical nosocomial infections

(pneumonia, urinary tract

infections, catheter infections)
NOSOCOMIAL
INFECTIONS
 Occurs after the initial 48
hours of admission
 • Urinary tract infection
 • (IV) Catheter-related
infection
 • Lower respiratory tract
infection
 • Infection via transfusion

PATHOGENESIS
 DETERMINANTS OF
INFECTIONS
 Microorganism
 Host Defenses
(virulance) (type&severity of
immunosupression)
 INFECTION Environment
 (Fluids, foreign bodies, a
closed unperfused space etc.)
Infectious agent
 The Endogenous Gastrointestinal
Microflora
 • Stomach
 • Duodenum Aerobes and
anaerobes
 • Proximal small bowel <104/mL
 • Distal small bowel
Enterobacteriaceae Enterococcus
spp 103-108/mL Anaerobic
organisms
 • Colon Anaerobic organisms
Bacteriodes fragilis 1012/mL
Microbiology of Intraabdominal
Infections
 Aerobes:
 Escerichia coli
 Klebsiella spp.
 Proteus spp
 Enterobacter spp
 Enterococcus spp
 Anaerobes:
 Bacteriodes spp
 Peptostreptococcus spp
 Clostridium spp
 Bilophila wadsworthia
 Fungi,Candida
HOST DEFENSE
MECHANISMS
 Nonspecific
 Surface Mechanical barrier
 (skin, mucosa) Secretory
barrier Immunoglobulins
 Ciliary motion Movement
HOST DEFENSE
MECHANISMS
 Specific
 Cellular defense Phagocytic cells
Cell-mediated immunity (PNLs,
eosinophils, mononuclear cells) (T
lymphocytes & macrophages)
 Natural killer cells
 Humoral defense Lyzozyme
Immunoglobulins
 Complement
 Interferon
A Susceptible host
 Causes of Impaired Host Resistance to Infection
 Patient’s Underlying Condition
 • AIDS
 • Remote infection
 • Neoplasia
 • Malnutrition
 • Acute stress
 (burns, trauma)
 • Metabolic illness
 (DM, uremia)
 • Aging
 • Obesity
 • Smoking
A Susceptible host
 Iatrogenic
 • Antineoplastic
 chemotherapy
 • Immunosuppressive
 therapy
 (allograft recipients,
 autoimmune disorders)
 • Splenectomy
Infection Environment
 Wound or a natural space with
narrow outlets

 Fluids, foreign bodies, a closed

unperfused space etc
 Clinical finding
 LOCAL MANIFESTATIONS OF SURGICAL
INFECTIONS
 • CELLULITIS: Spreading infection of the

skin and subcutaneous tissue

 • LYMPHANGITIS: Inflammation of the

lymphatic channels in the subcutaneous

tissue
 • ABSCESS: Localized accumulation of

purulent
material situated in the dermis or
subcutaneous
tissue
SURGICAL SITE
INFECTION
 The term “surgical site infection”
now replaces “surgical wound
infection”
 • Superficial incisional SSI;

involves the skin or subcutaneous

tissue
 • Deep incisional SSI;

involves the deep tissue such as

fascia or muscle,Organ/space SSI
SURGICAL SITE INFECTION
DEFINITION
 Superficial Incisional Infection
 Any incisional infection occuring within
postoperative 30 days at any level above
fascia described as;
 • Presence of any purulant discharge
(culture may not reveal any opponent)
 • Any positive culture findings from
primarily closed incision
 • Deleberate incision exploration
 • Infection diagnosis determined by the
surgeon
 SURGICAL SITE
INFECTION
DEFINITION
 Deep Incisional /Organ / Space Infection
 Any infection occuring within
postoperative 30 days or within
postoperative one year if any implant is
left
 described as;
 • Presence of any purulant discharge
(through drains)
 • Any positive culture findings from
intraabdominal samples
 • Spontaneous wound dehiscence
 • Presence of abscess
 • Infection diagnosis determined by the
surgeon
 Diagnosis
 • Redness
 • Swelling
 • Hyperthermia
 • Fluctuation
 • Purulent or turbid aspirate
OPERATIVE WOUNDS
 NATIONAL RESEARCH COUNCIL
CLASSIFICATION OF OPERATIVE
WOUNDS
CLASSIFICATION OF OPERATIVE
WOUNDS

 CLEAN
 • Nontraumatic
 • No inflammation encountered
 • No break in technique
 • Respiratory, alimentary,
genitourinary tracts not
entered
CLASSIFICATION OF OPERATIVE
WOUNDS
 CLEAN CONTAMINATED
 • Gastrointestinal or respiratory tracts
entered without significant spillage
 • Appendectomy
 • Oropharynx entered
 • Vagina entered
 • Genitourinary tract entered in absence
of infected urine
 • Biliary tract entered in absence of
infected bile
 • Minor break in technique
CLASSIFICATION OF OPERATIVE
WOUNDS

 CONTAMINATED
 • Major break in technique
 • Gross spillage from
gastrointestinal tract
 • Traumatic wound, fresh
 • Entrance of genitourinary or
biliary tracts in presence of
infected urine or bile
CLASSIFICATION OF OPERATIVE
WOUNDS
 DIRTY and INFECTED
 • Acute bacterial inflammation
encountered, without pus
 • Transection of clean tissue for the
purpose of surgical access to a
collection of pus
 • Traumatic wound with retained
devitalized tissue,foreign bodies,
fecal contamination, and/or delayed
treatment, or from dirty source.
Treatment
 Principles of Antibiotic Therapy
 • Why to use antibiotics?
 • Where is infection?
 • What are the most probable
pathogens?
 • How about antibiotic
susceptibility?
 • Pharmacological properties
 • Is combination of antibiotics
necessary?
 • Host factors
 • Monitoring accuracy of therapy