Surgery wound infections

The characteristic of this genus is that its members are anaerobes. They occur in the alimentary tract of humans and animals and have been associated with wound infections, especially after surgery. Bacteroidesfragilis is a frequently encountered member of the genus. 

Louis Pasteur (1822-1895) established that some diseases are caused by microorganisms and not, as was thought to be the case at the time, by miasmas, evil spirits or divine intervention. Despite the scepticism of physicians, as illustrated above, Pasteur s work inspired a British surgeon, Joseph Lister, to introduce antiseptic methods into surgery in order to prevent wound infection. In March 1865, he operated for the first time using an antiseptic, carbolic acid (phenol). There were no infections after the surgery - a rare occurrence at that time. 

The complications following surgery include haemorrhage, wound infection, recurrent laryngeal nerve damage, and transient (up to 20% of cases) or permanent (2%) hypocalcaemia. After near-total thyroidectomy relapse of hyperthyroidism should be rare, and this operation has largely replaced the older approach of sub-total thyroidectomy which had higher relapse rates. 

A combination of neomycin and nonabsorbable erythromycin base given orally prior to colorectal surgery can markedly reduce the incidence of postoperative wound infection. Orally administered neomycin is sometimes used to suppress the facultative flora of the gut in patients with hepatic encephalopathy. It is unclear how this improves coma, but one theory is that it reduces systemic absorption of the bacterial metabo-htes that allegedly cause hepatic encephalopathy. Although more than 95% of an oral dose of neomycin is excreted unchanged in the stool of normal subjects, the bioavaUabUity of neomycin may be much higher in patients with an abnormal gastrointestinal mucosa. 

Various antimicrobials agents is used in dentistry for prevention of local oral wound infection and prevention of distant infection i.e., bacterial endocarditis. Generally, prophylaxis by the use of antibiotics is not required for routine type of dental surgery... 

Richet, H.M. et al. A Cluster of Rhodococcus (Gordona) bronchialis Sternal-Wound Infections after Coronary-Artery Bypass Surgery. N. Eng. J. Med, 104... 

Fumary AP, Kerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Annals of Thoracic Surgery 1999, 67, 352-360. 

Use of systemic antibiotics should be limited to infectious or pronounced superinfected wounds. Only few situations in dermatologic surgery require prophylactic antibiotics, since in cutaneous surgery postoperative infections are too infrequent and insufficiently severe to justify preventive antibiotics. 

Rotter, M.L. et al., A comparison of the effects of preoperative whole-body bathing with detergent alone and with detergent containing chlorhexidine glucontate on the frequency of wound infections after clean surgery. J. Hosp. Infect. 11, 310-320, 1988. 

In 139 consecutive patients who underwent major gynecological surgery and in whom 32% dextran 70 had been used as an anti-adhesion adjuvant (the mean amount of dextran used was 183 ml), there was an acceptably low rate of complications (34). Adverse effects involved 11 patients and included postoperative ileus (2.9%), pleural effusion (2.2%), allergic reactions (1.4%), wound infection (1.4%), and labial sweUing (0.7%). There was no evidence of an increased infection rate. 

The least common form of human botulism, botulism from intestinal colonization, includes cases in patients greater than 1 year of age not associated with ingestion of contaminated food or wound infection with the only possibility being intestinal colonization (38). Stool in these patients will contain toxin and C. botulinum, and the suspected food may contain spores without preformed toxin. Some cases occur in patients with a history of gastrointestinal surgery or inflammatory bowel disease, conditions that could support enteric colonization of B. botulinum (38). In 2001, in the United States, one case of adult colonization botulism occurred in a 45 year old who survived (39). 

Escherichia coli Negative Urinary tract and wound infections, common in the gastrointestinal tract and often causes problems after surgery, accounts for about 25 per cent of hospital infections... 

Polk HC, Christmas AB. Prophylactic antibiotics in surgery and surgical wound infections. Am Surg 2000 66 105—111. 

IG Gray, MIR Lee. The effect of topical povidone iodine on wound infection following abdominal surgery. Br J Surg 68 310-313,1981. 

DE Lilienfeld, D Vlahov, JH Tenney, IS McLaughlin. On antibiotic prophylaxis in cardiac surgery a risk factor for wound infection. Ann Thorac Surg 42(6) 670-674, 1986. 

A Brandberg, J Holm, Hammarsten, T Schersten. Postoperative wound infections in vascular surgery effect of preoperative whole body disinfection by shower-bath with chlorhexidine soap. In H Maibach, R Aly, eds. Skin Microbiology Relevance to Clinical Infection. New York Springer-Verlag, 1981, pp 98-102. 

O Wihlborg. The effect of washing with chlorhexidine soap on wound infection rate in general surgery a controlled clinical study. Ann Chirurg Gynacol 76 263-265, 1987. 

L Brote, B Nilehn. Wound infections in general surgery with special reference to the occurrence of Staphylococcus aureus. Scand J Infect Dis 8 89-97, 1976. 

Lawrence, J.C., 1994. Dressings and wound infection. American Journal of Surgery 167 (1 A), 21S-24S. 

Post discharge Wound infection After back surgery, the patient returned to the hospital with an infection requiring reopening of the wound... 

Wound infection The patient had surgery on the arteries of his legs. He developed a wound infection requiring a return to hospital for additional surgery and treatment... 

Hospitalizations were frequently prolonged in the early days, when devices were large, surgery was more involved, and catastrophic complications, such as lead dislodgement, perforation, and wound infections were frequent. The prospect of a brief hospital stay would appear heretical and unthinkable. Today, where experience is high and surgery is limited, complications are rare. Most important, the major concern over lead dislodgement, potential asystole is virtually nonexistent with the newer modem, positive electrode systems. With respect to pacemakers, if one reflects on the current pacemaker... 

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