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Surgery Essay

Describe the types of


staphylococcal infections
encountered in surgical practice
and outline their treatment.
Normal body flora is usually involved in infections in surgical
patients. Staphylococci are such organisms: normal
commensals of the skin, oropharynx and nasopharynx.

Staphylococcus aureus is an important pathogen in many


surgical infections such as wound infections and device related
infections. The latter include infections of indwelling catheters
and prosthetic joints. Due to its coagulase enzyme, plasma is
coagulated, resulting in fibrin deposition which interferes with
phagocytosis and increase the ability of the organism to invade
tissues causing septicaemia, including infective endocarditis,
deep abscess in the brain, liver and spleen and toxic shock
syndrome (TSS). TSS is due to the ability of the staphylococcus
aureus to produce enterotoxins, which bind to cytokines
causing TSS.

Coagulase negative effectively means non Staphylococcus


aureus staphylococci, for example Staphylococcus epidermis.
These are usually dismissed as contaminants, but they are
increasingly the cause of line and prosthesis infections,
particularly in imuunocompromised patients. The organism
colonizes plastic devices by attaching firmly to artificial
surfaces. Some strains also produce a slime layer, glycocalyx,
which appears to facilitate adhesion and protect organisms

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Surgery Essay

from antibiotics and host defences. Staphylococcus epidermis


infection may cause bacterial endocarditis especially in people
with prosthetic heart valves.

The treatment of staphylococci includes second generation


cephalosporins such as cefuroxime. This is given mostly
intravenously and has a very broad spectrum against both
gram positive and negative bacteria. Gentamycin, an
aminoglycoside is another good option. Penecillins such as
benzylpenecillin and co-amoxiclav are now insensitive. As
antiseptics, chlorhexadine and povidone-iodine are sensitive.

Methicillin- resistant Staphylococcus aureus (MRSA) is


resistant to all cephalosporins. Advancing age lengthy
hospitalization, stays in ITU, chronic illness, prior and prolonged
antibiotic therapy are all risk factors for infection. Patients will
present with a pneumonia, surgical site infection, intra-
abdominal sepsis and toxic shock syndrome. In these patients,
vancomycin is the antibiotic of choice. Teicoplanin is used if the
organism is insensitive to vancomycin. Flucloxacilin may also
be used against MRSA.

17/01/09