Wounds postoperative infections

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. 

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. 

Rare reactions include hypersensitivity reactions, lymphopenia, malignancies, and serious infections requiring hospitalization (such as abscess, pneumonia, and postoperative wound infection),... 

Hypersensitivity reaction, malignancies, serious infections (abscess, cellulitis, postoperative wound infection, pneumonia), thrombocytopenia, and worsening of psoriasis occur rarely. 

The Study of the Efficacy of Nosocomial Infection Control (SENIC) identified four independent risk factors for postoperative wound infections operations on the abdomen, operations lasting more than 2 hours, contaminated or dirty wound classification, and at least three medical diagnoses. Patients with at least two SENIC risk factors who undergo clean surgical procedures have an increased risk of developing surgical wound infections and should receive antimicrobial prophylaxis. 

Lowry, P.W. et al. A Cluster of Legionella Sternal-Wound Infections Due to Postoperative Topical Exposure to Contaminated Tap Water," N. Eng. J. Med., 109 (January 10, 1991). 

A 56-year-old woman with a postoperative wound infection developed the serotonin syndrome when she was given the antibiotic linezolid intravenously (22). The dose of paroxetine had been tapered and it had been withdrawn 5 days before. 

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. 

Currently the most important hospital-acquired pathogen is methicillin-resistant Staph, aureus, which is responsible for a range of serious infections such as pneumonia, postoperative wound infection and skin infections which may in turn be complicated by bloodstream spread. The use of vancomycin and teicoplanin has escalated as a consequence, and in turn has been linked to the emergence of vancomycin-resistant enterococci. 

Postoperative wound infection Posttrauma wound infection Diabetic foot Decubitus ulcer Bone and joint infections... 

Prophylactic antibiotics not shown to reduce incidence of wound infection after urological procedures. Bacteriuria is most common postoperative complication only patients with evidence of infected urine should be treated with antibiotics directed against the specific pathogens isolated. 

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. 

Several investigators, including Brandberg and Andersson [33], have shown that showering with a nonantimicrobial soap actually increases the level of the microbial flora. Earlier studies by Cruse and Ford [31] and Dineen [38] had recognized and established the patient s own skin as an importance source of postoperative wound infection. 

Ariyan S, Marfaggi RA, Harden G, et al. (1980) An experimental model to determine the effects of adjuvant therapy on the incidence of postoperative wound infection. I. Evaluating Preoperative Radiation Therapy. Plast Reconstr Surg 65328-337... 

In patients with vascular access, the probability of dialysis access-related infection is considerably less for patients with native arteriovenous fistulae than for those with synthetic grafts [36]. Postoperative wound infection as well as poor aseptic technique at dialysis may cause infection of the fistula silent infec-... 

The possibility to develop a surgical site infection depends on bacterial colonization of the operative field. Perioperative antibiotics are central to prevent postoperative surgical wound infection [15]. To reach the best effect, timing of administration of the single-shot antibiotic prophylaxis is crucial 30-60 min before skin incision is adequate. Errors due to too early or too late medication put the patient at risk for an infection. 

Observational studies The effect of early enteral feeding in children undergoing stoma closure has been evaluated in a mid-level socioeconomic setting. Early enteral feeding was associated with a reduction in postoperative fever and wound infections compared with feeding without any specific protocol [129 ]. 

Further common postoperative complications include superficial wound infection or deep sternal infection (retrosternal infection - mediastinitis). Prophylactic antimicrobial therapy should therefore be routinely employed. Deep wound infection in an inununocompromised patient always indicates a life-threatening situation and requires both extensive surgical intervention and aggressive antimicrobial therapy. 

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. 

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. 

Acute pelvic, bone, intra-abdominal, joint, respiratory tract, burn wound, postoperative, and skin or skin-structure infections-, complicated UTIs septicemia meningitis IV, IM... 

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. 

In the case of ocular hypotony and a positive Seidel s sign with a formed anterior chamber in the early postoperative period, the treatment of choice is to discontinue the steroid to encourage wound closure and avoid secondary infection. The patient should be placed on a third- or fourth-generation topical fluoroquinolone. A topical aqueous suppressant may also be used to ensure secure wound closure.The patient is asked to limit activities and is given an eye shield to wear at night. An alternative treatment may include the use of a topical antibiotic and a 24-hour pressure patch with an eye shield while sleeping. If the wound feils to seal after several days to 1 to 2 weeks, surgical repair should be considered. 

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