Surgical infection

Table 74—2 presents the recommended agents for treatment of community-acquired and complicated intraabdominal infections from the Infectious Diseases Society of America and the Surgical Infection Society.21-23 These recommendations were formulated using an evidence-based approach. Most community-acquired infections are mild to moderate, whereas health care-associated infections tend to be more severe and difficult to treat. Table 74-3 presents guidelines for treatment and alternative regimens for specific situations. These are general guidelines there are many factors that cannot be incorporated into such a table. 

Mazuski JE, Sawyer RG, Nathens AB, et al. The Surgical Infection Society guidelines on antimicrobial therapy for intraabdominal infections An executive summary. Surg Infect 2002 3 161-174. 

Correct timing of antibiotic administration is imperative to preventing SSI. The National Surgical Infection Prevention Project recommends infusing antimicrobials for surgical prophylaxis within 60 minutes of the first incision. Exceptions to this rule are fluoroquinolones and vancomycin, which can be infused 120 minutes prior to avoid infusion-related reactions.1 No consensus has been reached on whether the infusion should be complete prior to the first incision. However, if a proximal tourniquet is used, antibiotic administration should be complete prior to inflation. 

The National Surgical Infection Prevention Project and published evidence suggest that the continuation of antimicrobial prophylaxis beyond wound closure is unnecessary.1 Studies have not shown benefit for additional doses of antibiotic and the duration of antimicrobial prophylaxis should not exceed 24 hours. Longer durations of antibiotic prophylaxis are advocated by some guidelines and will be discussed later. 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

Bratzler DW, Houck PM, for the Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005 189 395-404. 

Resistance to a combination of trimethoprim-sulfamethoxazole is always less frequent than when any of these drugs is used separately. This combination of drugs, which is known by the commercial names cotrimoxazole, bactrim, biseptol, sulfatrim, and many others, is used for treating infections of the respiratory tract, infections of the urinary tract, gastric infections, surgical infections, enteritis, meningitis, and other diseases. 

Bacterial superficial skin infections including cellulitis and erysipelas, furunculosis and impetigo usually have a benign course. Infections of the subcutis often lead to necrosis of soft tissue. These infections are described in section 16 (surgical infections). Arthritis involves infection of the synovia and... 

Although the need for surgical intervention distinguishes most intra-abdominal infections from non-surgical infections, antimicrobial agents also play a major role in controlling sepsis and limiting the extent of dissemination of the infection in abdominal sepsis. In clinically stable patients without... 

It is produced by an Actinomyces. Used in the treatment of anaerobic and mixed surgical infections and lung abscess. 

It is a broad spectrum cephalosporin having a long half life and administered once daily and indicated in meningitis, septicaemia, typhoid, urinary tract infections, prophylaxis in surgical infections, pneumonia, STD, bacteremia and pelvic inflammatory disease. 

Tsulukidze AP (1957) Results of phage application for treatment of surgical infections. In Bacteriophages. Tbilisi, Georgia, pp 99-108... 

Staphylococcus auretAs Skin abscesses, impetigo, cellulitis, pneumonia, septic arthritis, osteomyelitis, toxic-shock syndrome, enterotoxin food poisoning, surgical infections Blepharitis, hordeolum, conjunctivitis, dacryocystitis, corneal ulcer, preseptal and orbital cellulitis, endophthalmitis... 

Staphylococcus epidermidis Trauma and surgical infections Blepharitis, hordeolum, conjimctivitis, dacryocystitis, corneal ulcer, endophthalmitis... 

Cefotaxime Claforan IV, IM Pneumonia, genitourinary tract infections, gynecological infections, bacterial septicemia, bone and joint infections, meningitis, prophylaxis of surgical infections, intra-abdominal infections... 

The principles upon which drugs are used pro-phylactically to prevent surgical infections are based on human studies there are few veterinary studies that evaluate these recommendations. 

Edmondson, H. T. Parenteral and oral clindamycin therapy in surgical infections a preliminary report. Am. Surg. 1973, 168, 637-642. 

Toloza EM, Wilson SE. Cholecystitis and cholangitis. In Fry DE, ed. Surgical Infections. Boston, Little, Brown, 1995 254—263. 

Christou NV, Barie PS, Dellinger EP, et al. Surgical infection society intraabdominal infection study. Arch Surg 1993 128 193-199. 

Mitka M. Preventing surgical infection is more important than ever. JAMA 2000 283 44 5. 

Balague Ponz C, Trias M. Laparoscopic surgery and surgical infection. J Chemother 2001 13 17-22. 

In systemic or focal disease antibiotics should be administered for a longer period of 3 weeks. In the event of abscess formation, it should be drained surgically. Infected aneurysms, heart valves and joints usually require prolonged courses of antibiotics and surgical intervention. 

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