Infections postoperative

Because of its acidity, phenol was known as carbolic acid when Joseph Lister introduced it as an antiseptic in 1865 to prevent postoperative bacterial infections that were then a life-threatening hazard in even minor surgical procedures. 

Phenol was the first commercial antiseptic its introduction into hospitals in the 1870s led to a dramatic decrease in deaths from postoperative infections. Its use for this purpose has long since been abandoned because phenol burns exposed tissue, but many modern antiseptics are phenol derivatives. Toluene has largely replaced benzene as a solvent because it is much less toxic. Oxidation of toluene in the body gives benzoic acid, which is readily eliminated and has none of the toxic properties of the oxidation products of benzene. Indeed, benzoic acid or its sodium salt (Na+, C6H5COO ions) is widely used as a preservative in foods and beverages, including fruit juices and soft drinks. 

The cephalosporins also may be used perioperatively, that is, during the preoperative, intraoperative, and postoperative periods, to prevent infection in patients having surgery on a contaminated or potentially contaminated area, such as the gastrointestinal tract or vagina In some instances, a specific drug may be recommended for postoperative prophylactic use only. 

C. a reduction of intestinal bacteria lessens the possibility of postoperative infection... 

Pulmonary disease, small-cell lung cancer, head trauma, stroke, central nervous system infections, pituitary surgery, prolactinoma, severe nausea, psychiatric disease, and postoperative state... 

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

Brain abscesses are localized collections of pus within the cranium. These infections are difficult to treat due to the presence of walled-off infections in the brain tissue that are hard for some antibiotics to reach. In addition to appropriate antimicrobial therapy (a discussion of which is beyond the scope of this chapter), surgical debridement is often required as an adjunctive measure. Surgical debridement also may be required in the management of neurosurgical postoperative infections. 

Peritonitis may be classified as primary, secondary, or tertiary. Primary peritonitis, also called spontaneous bacterial peritonitis, is an infection of the peritoneal cavity without an evident source of bacteria from the abdomen.1,2 In secondary peritonitis, a focal disease process is evident within the abdomen. Secondary peritonitis may involve perforation of the gastrointestinal (GI) tract (possibly because of ulceration, ischemia, or obstruction), postoperative peritonitis, or posttraumatic peritonitis (e.g., blunt or penetrating trauma). Tertiary peritonitis occurs in critically ill patients and is infection that persists or recurs at least 48 hours after apparently adequate management of primary or secondary peritonitis. 

O Primary peritonitis develops in up to 25% of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder appendicitis pancreatitis diverticulitis bowel infarction inflammatory bowel disease cholecystitis operative contamination of the peritoneum or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intraabdominal infection. In 1998, 278,000 appendectomies were performed in the United States for suspected appendicitis.5... 

Without Vascular Insufficiency Adult (greater 50 years) Postoperative (e.g., hip fractures), soft-tissue infections 5. aureus Nafci 11 i n or cefazolin... 

Data reported by the NNIS from 1990 to 1996, adapted from National Academy of the Sciences National Research Council. Postoperative wound infections The influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 1984 160 32-135. 

The role of Enterococcus as a pathogen is not clear. Enterococcal infection occurs more commonly in postoperative peritonitis, in the presence of specific risk factors indicating failure of the host defenses, or with the use of broad-spectrum antibiotics. 

SSIs are classified as either incisional (such as cellulitis of the incision site) or involving an organ or space (such as with meningitis). Incisional SSIs may be superficial (skin or subcutaneous tissue) or deep (fascial and muscle layers). Both types, by definition, occur by postoperative day 30. This period extends to 1 year in the case of deep infection associated with prosthesis implantation. 

Postoperative therapeutic antibiotics may be indicated if perforation is detected during surgery, depending on whether an established infection is present. 

Detection of an active infection during surgery (gangrenous gallbladder, suppurative cholangitis) is an indication for therapeutic postoperative antibiotics. 

Established intraabdominal infections require appropriate therapeutic postoperative antibiotics. 

Cefazolin, 2 g IV, remains the drug of choice. Providing a broader spectrum by using cefoxitin against anaerobes or piperacillin for better coverage against Pseudomonas or enterococci, for example, does not lower postoperative infection rates any further in comparative studies. 

Vaginal hysterectomies are associated with a high rate of postoperative infection when performed without the benefit of prophylactic antibiotics. 

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used to treat HIV-infected patients that causes mild to severe skin rash and even Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) in a substantial proportion (16%) of patients. Nevirapine also induces hepatotoxicity. These adverse clinical symptoms may also occur in non-HIV subjects taking the drug as postoperative prophylaxis [15]. 

Resistance Increased resistance to the drug is frequently encountered in fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies. Ml, cancer, and postoperative states. 

Prophylaxis-To prevent postoperative infection in clean contaminated or potentially contaminated surgery in adults, give a single 1 or 2 g IV dose 30 to 60 minutes prior to surgery. In patients undergoing cesarean section, give the dose as soon as the umbilical cord is clamped. 

Skin and skin structure infections Skin and skin structure infections, including those associated with postoperative wounds, ulcers, and burns caused by . coli, P. mirabilis, S. marcescens, Enterobacter sp., P. aeruginosa, K. pneumoniae, and Citrobacter sp. 

Prophylaxis To prevent postoperative infection in contaminated or potentially contaminated colorectal surgery, the recommended adult dosage is 15 mg/kg infused over 30 to 60 minutes and completed about 1 hour before surgery followed by 7.5 mg/kg infused over 30 to 60 minutes at 6 and 12 hours after the initial dose. Complete administration of the initial preoperative dose about 1 hour before surgery so that adequate drug levels are present in the serum and tissues at the time of initial incision, and administer, if necessary, at 6-hour intervals to maintain effective drug levels. Limit prophylactic use to the day of surgery only. 

For debridement of necrotic tissue and liquefication of slough in acute and chronic lesions such as pressure ulcers, varicose, diabetic, and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles, and miscellaneous traumatic or infected wounds. Also stimulates vascular bed activity to improve epithelization. 

Gyssens 1C. Prevention of postoperative infections current treatment recommendations. Drugs 1999 57 175-85. 

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