Surgery Group 5 A:

BALATERO, ANNA MAE

BALETA, CHRISTINE
BALLENER, JE OLIVE
BECIOS, ENA MAE

INFECTIONS OF
SIGNIFICANCE

PREVENTION AND
TREATMENT OF SURGICAL
INFECTIONS
Surgical Site Intra-Abdominal Organ-Specific Skin and Soft tissue

Primary microbial Pyogenic Liver Superficial/Skin

Risk factors Pre-Operative Intraoperative Postoperative
peritonitis abscesses structure infections
Factors Factors Factors
Age, DM, Carrier state,
Obesity, Immunosuppression, MC agents: E coli, K MC agents: E coli, K + Cellulitis
Patient Anemia, Renal failure, CSD and S pneumoniae, pneumoniae, Enteric + Erysipelas
+ > 250 neutrophils/L bacilli, Enterococci, + Lymphangitis
Blood transfusion, Hypoxia, Pseudomonas spp., Sterile technique in
Pre-Operative Hair Operating Room Surgical instruments sterilized Incisional care
Local Hypothermia, Local tissue Bacteroides spp., No hair should be removed changing dressing
Removal Environment Ventilation
necrosis, IAP, PSP Diagnosis: PE anaerobic Treatment: Antibiotics unless necessary
Maintained at positive pressure
findings streptococci,
Toxin secretion, Prolonged + > 250 neutrophils/L Fusobacterium spp., Hair Clipping>Hair shaving
Microbial Community-acquired
hospitalization, Clearance C albicans -Maintain Integrity of healing
MRSA incision
resistance Discharge Teaching
Treatment: Antibiotic Core Body Patient maintained at -Educate patient about S/S of
Patient Skin Aseptic Agents:
Wound class administration for 14- Splenic abscesses Management: -Iodophors Temperature > 36.5°C infection
Operation
21 days Adequate drainage -Alcohol containing agents
Ex. Hernia repair,
and administration of -Biguanides
breast biopsy extremely rare and first-line antibiotics
Clean (Class I) EIR: 1-2 % Secondary microbial are treated in a
peritonitis similar fashion liver Increased Oxygen Facilitate phagocytic eradication
Ex. Cholecystectomy, Aggressive Soft Delivery of microbes
Elective GI surgery abscess tissue infections
Clean/Contaminated Pre-operative Hand Aseptic agents
EIR: 2.1-9.5 % due to perforation or Alcohol hand rub
(Class II) severe inflammation Anti-sepsis
Ex. Colorectal surgery Recurrent abscesses Sterile gloves
EIR: 4-14 % and infection of intra- Meleney's synergistic
may require operative
abdominal organ gangrene Eradicating dead space
Contaminated Ex. PAT, LTI, Enterotomy intervention-- Good Surgical
Fournier's gangrene Removing devitalized tissues
(Class III) during bowel obstruction unroofing and technique
Gas gangrene Using drains,suture materials correctly
EIR: 3.4-13.2 % marsupialization or Keep fingernails short
Management: Resect Necrotizing fasciitis Other Preparations
splenectomy Remove hand accessories
Dirty or repair the diseased
(Class IV) Ex. Perforated diverticulitis, organ; debridement of
Necrotizing soft tissue Management:
necrotic, infected Secondary pancreatic Require immediate
infections tissue and debris, Sutures Monofilament sutures>braided sutures
infections surgical intervention
EIR: 3.1-12.8 % administration of plus administration of Aqueous Povidone-iodine
antimicrobial agents antimicrobial agents Antimicrobial Soaps Chlorhexidine
occur approximately
10- 15 % of patients
Tertiary microbial who develop severe
peritonitis pancreatitis with Drains Closed suction drains>Open drains
necrosis Optimal time: 60 min before
Antimicrobial
incision
Prophylaxis
MC agents: E faecalis Timing is very important
and faecium, S
epidermidis, C
albicans

Biologic Warfare
SURGICAL INFECTIONS Incubation
Text Agents
1 to 6 days

Postoperative S/Sx malaise, myalgia, fever,

Bacillus anthracis respiratory distress, chest pain,
Nosocomial
Infection (Anthrax) diaphoresis, widened
mediastinum, pleural effusions

Microbiology of
Pathogenesis Treatment
Infectious Agents Ciprofloxacin,
Doxycycline,
Infection associated
Prolonged Amoxicillin,
with Indwelling
Bacteria Fungi Viruses Prevent microbial Postoperative UTI Mechanical Clindamycin,
goal Host Defenses intravascular
infection Ventilation Rifampin
catheters

Responsible for Identified Identified

initially by culture by the presence of Limit proliferation of
majority of surgical Barriers
and lastly by media at viral DNA or RNA microbes Incubation
infections Used for Prevention
different temperature using PCR Diagnosis Treatment Prevention 10 to 12 days
Contain or eradicate Nosocomial
Identified using Gram invading microbes Epithelial surface Mucosal surface > 10^4 CFU/mL in Pneumonia Physiological monitoring,
Polymicrobial full barrier precautions and
stain and culture for Cause nosocomial Adenovirus symptomatic Single Antibiotic for 3-5 immediate indwelling vascular access, drug
infections or fungemia Chlorhexidine skin prep
classification of infections in surgical Cytomegalovirus days catheter removal delivery, & hyperalimentation
bacteria C. albicans and Maintain sterility in S/Sx
patients Epstein-Barr Virus Integument >10^5 in asymptomatic malaise, fever, vomiting,
related species the distal bronchi and Respiratory Tract Urogenital, biliary, Gastrointestinal Tract Smallpox
Herpes Simplex Virus headache, centripetal rash
Varicella-Zoster Virus alveoli pancreatic, distal
Gram (+) Gram (-) respiratory tracts
Mucor Rare causes of Diagnosis Prevention
Chemical secretes by Vast number of
Rhizopus aggressive soft tissue Respiratory mucus Oropharynx
sebaceous gland microbes Treatment
Absidia infections traps larger particles,
Stained BLUE Stained RED/PINK Upper Respiratory No resident microflora Cidofovir
Microbes are held including microbes Purulent Sputum, elevated leukocyte immediate weaning of
Tract
and is cleared by Due to acidic, low- count, fever, chest X-ray abnormalities Mechanical Ventilator
Aspergillus fumigatus, coughing motility environment,
Constant shedding of
Aerobic skin Bacilli niger, terreus, and organisms are
Opportunistic epithelial cells
commensals Enterobacteriaceae other spp. routinely killed after Transmission
pathogens that cause
Contribute to a large Staphylococcus E. coli Blastomyces ingestion flea bites from
infection to Small particles are
percent of surgical aureus Klebsiella dermatitidis Lower Respiratory rodents
immunocompromised cleared by
site infection (SSIs) Staphylococcus pneumoniae Coccidioides immitis Blocks attachment Tract Stomach
host phagocytosis
pyogenes Serratia marcescens Cryptococcus and invasion of non Resident microflora Small numbers of
and epidermidis Enterobacter neoformans commensal microbes microbes populate
Citrobacter gastric mucosa S/Sx
Acinetobacter Sepsis Resistant Organisms Blood-Borne Pathogens Yersinia pestis painful enlarged lymph node,
Nosocomial (~102 to 103
infections in Enteric organisms Pseudomonas Gram (+) aerobic (Plague) fever, severe malaise
P. aeruginosa and microbes colony forming units
immunocompromised E. faecalis CFU/mL)
flourescens Genus
or chronically ill E. faecium
Stenotrophomonas Staphylococcus
patients Treatment
Streptococcus Treatment
Microbes populate Resuscitation Doxycycline,
Corynebacterium Treatment Streptomycin,
gastric mucosa endpoints
Propionibacterium Cellular Mechanisms 1st, 2nd, or 3rd Cephalosporins Aminoglycoside,
Enterococcus Terminal ileum (105 to 108 of resistance
Transmission of HIV
Carbapenem Fluoroquinolone,
E. coli colony forming units MAP: > 65mmHg
Broad-spectrum antibiotics Chloramphenicol
Enterobacteriaceae CFU/mL) UO: > 0.5 mL/kg/hr
Vasopressor Therapy
Candida albicans Normalization of Serum lactate
Prevention
Due to low oxygen,
static environment, Target site
modification Transmission
Facultative anaerobic there is exponential
microbes Aerobic microbes growth of microbes Universal Precaution Tick
Bacteriodes fragilis E. coli Anerobes:Aerobes
and ditasonis Enterobacteriaceae 100:1
Distal colon Changes in bacterial
Eubacterium E. faecalis
Fusobacterium and faecium permeability or S/Sx
Lactobacillus C. albicans antibiotic intake Francisella tularensis cough, pneumonia, enlarged
Feces microbes are (Tularemia) lymph nodes
Peptostreptococcus careful handling &
~1011 to 1012 CFU/g washing hands and
routine use of barriers disposal of sharp
other skin surfaces
instruments
activation of drug
efflux systems Treatment
Aminoglycoside,
Doxycycline,
Ciprofloxacin

drug deactivation