Professional Documents
Culture Documents
congenitally immunocompromised
5. Colon - polymicrobial
extremes of age
anaerobes (95-99%)
bacteroides antibiotics for
steroids
anaerobes
cancer therapy: chemo, radiation
bifidibacteria
tx: incisional drainage + antibiotic
clostrida
metronidazole,
S. aureus = non-foul smelling;
eubacterium
lactobacillus clindamycin
E. coli = fouls smelling
peptostreptococcus
aerobes
E. coli
Carbunle
enterobacteria
crater-like, cluster of boils enterococci
polymicrobial: Staph and Strep candida
if with MRSA, tx: linezolin bacterial translocation to blood vessels is
and necessary debridement of wound termed bacteremia.
Cellulitis
streptococcal = thin and watery
treatment: ??
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Microbial infection
Sterile areas
areas without the presence of bacteria
Infection: documented
presence of
microorganism
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INFECTIONS OF SIGNIFICANCE IN SURGICAL
I. RT, GU, GI entered
PATIENTS
CLEAN uninfected, no
Surgical site infections (SSI)
contamination
Intra-abdominal infection
toxin secretion
2. Pancreatic abscess
polymicrobial
multibacterial - gram (-) aerobe
D. Soft tissue
1. Necrotizing fasciitis /
Fourniers disease
anaerobes
polymicrobial
source control
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2. Cellulitis
Anaerobes
streptococcus
3. Lymphangitis
Gram (+) Anaerobes
spreading cellulitis
streptococcus Clostridium difificile
Clostridium perfingens
C. tetani, C. septicum
Peptostreptococcus spp.
Bacteroides fragilis
Fusobacterium spp.
Virus
E. Post-op nosocomial infections
Cytomegalovirus
Review and memorize this table daw: Epstein-Barr virus
Hepatitis A, B, C
Herpes Simplex virus
Human immunodefficiency virus
Varicella zoster virus
Fungi
Enterococcus faecum
Enterococcus fecalis
Other Bacteria
Gram (-) Bacilli Mycobacterium avium-intercellulare
(*KEEPS*)
Mycobacterium tuberculosis
Escherichia coli * (old wound with multiple fistula)
Haemophilus influenzae Nocardia asteroides
Klebsiella pneumoniae * (black lesions which are highly contagious)
Proteus mirabilis
Enterobacter cloacae, aerogenes * Legionella pneumophilia
Serratia marcescens *
Acinetobacter calcoaceticus Listeria monocytogenes
Citrobacter fruendii
Pseudomonas aeruginosa *
Xanthomas maltophilia BAHAGHARI 15
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PREVENTION OF SURGICAL INFECTIONS
B. Prophylactic antibiotics
broad spectrum
given 30 minutes to one hour prior to incision
antibiotic should reach subcutaneous
tissue before cutting
repeat dosing for prolonged surgery (>4 hours) 1.Principles of antibiotic prophylaxis
discontinued within 24 hours select antibiotic for common bacteria on
surgical site
C. Shaving- done immediately prior to incision give antibiotics 30 mins before surgery
risk for micro-wounds redose antibiotics for prolonged operations
discontinue after 24 hours
D. Surgical scrub - routinely done
2. Empirical therapy
E. Prepping Progression from prophylactic therapy
7.5% betadine first -> 10% betadine no microbiologic data yet (C&S)
antiseptic effect is for 4 hours only gram stain available
short course of 3-5 days
TREATMENT OF SURGICAL INFECTIONS indications
intraoperative findings (Class I to III)
A. Organized approach to therapy includes the ff: critically ill patients
1. rapid rescuscitation sepsis, severe sepsis, septic shock
2. antibiotics discontinued after clinical improvement
3. source control
incision and drainage 3. Therapy of established infection
wound debridement C & S available
abdominal exploration (7 days before de-escalation therapy
air dissapears post op) narrower spectrum but more precise
amputation MONOMICROBIAL
most nosocomial infections
B. Appropriate antimicrobial use DURATION OF TREATMENT (monomicrobial)
Knowledge of microflora in area involved
lower GI = Anaerobes > Gram(-) >Gram (+) UTI 3-5 days
Knowledge of antimicrobial spectrum of activity
Monotherapy = Cefotixin or Cefotetan pneumonia 7-10 days
Polytherapy
Metronidazole + Cefuroxime bacteremia 7-14 days
Metronidazole + Aminoglycoside
Clindamycin + Quinolone endocarditis, 6-12 weeks
osteomyelitis, prosthetic
infections
Other applications POLYMICROBIAL
treated primarily by debridement
Diabetic foot = polymicrobial Culture and sensitivity less important
monotherapy: sultamicillin clinical course dictates if antibiotics need to
polytherapy: quinolone + clindamycin
be changed or not after C & S are out
Skin and soft tissue infection = gram (+)
monotherapy: Sultamicilin Impact of antibiotic misuse include:
polytherapy: quinolone + clindamycin increased health care cost, drug reactions and
toxicity, development of new infections like
Bowel perforation
Clostridium difficile colitis, and multi-drug resistance
if it smells like poop, chances are it is poop
Give clindamycin in nosocomial pathogens
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