Bacteriology:
Furuncles and boils may drain
Aerobes- E.coli, K. pneumonia, enteric
bacilli, enterococci, pseudomonas
Anerobes- Bacteroides, anaerobic
streptococci, Fusobacterium, C. albicans
Management:
Small (<1 cm) multiple abscess- should
be sampled and treated with a 4-6
weeks course of antibiotics
Larger abscess- percutaneous drainage
plus antibiotic therapy
2. Splenic Abscess
Rare and treatment is the same as liver
abscess
Recurrent hepatic or splenic abscess-
Surgical intervention by unroofing and
marsupialization or splenectomy
3. Secondary pancreatic infection
Severe pancreatitis with necrosis-
repeated pancreatic debridement of
infected pancreatic necrosis
(necrosectomy)
CT scan, ICU care, NO to routine use of
prophylactic antibiotic
Early enteral feeding thru nasojejunal
feeding tubes passed LOT decreased
development of infected pancreatic
necrosis due to a decrease of bacterial
translocation in the gut
INFECTIONS OF THE SKIN AND SOFT TISSUE
1. Superficial skin and skin structure
infections treated with antibiotics alone
Examples: cellulitis, erysipelas,
lymphangitis
2.
spontaneously or require surgical
incision and drainage plus antibiotics
Methicillin-Resistant Staph aureus-
require more aggressive and altered
antimicrobial therapy
Old Terminology:
Meleneys synergistic gangrene
Rapidly spreading cellulitis
Gas gangrene
Necrotizing fasciitis
New name: Based on soft tissue layer(s)
involvement and pathogens that causes them
Skin and superficial soft tissue
Deep soft tissue
Muscle
Patients at risk:
Elderly
Immunocompromised
Diabetic
Most commonly affected (in order)
Extremities
Perineum
Torso
Clinical manifestations:
dishwater pus- grayish, turbid
semipurulent material
Skin changes- bronze hue or brawny
induration
Blebs or crepitus
Pain at the site of infection
Treatment:
-Surgical Intervention-necrotic tissue
- Antibiotics gr (+), gr (-) aerobes and
anaerobes, Guided by culture and sensitivity
- Adjunct: hyperbaric oxygen for infection
caused by gas forming organism
IV Ig for Strep A infection with Toxic
Shock Syndrome, high risk of death,
elderly and those with hypotension and
bacteremia
POST OPERATIVE NOSOCOMIAL INFECTIONS
Examples: SSI- Surgical Site Infection
UTI- WBC or bacteria on urinalysis
Treatment: Antibiotics 3-5 days, removal of
foley catheter within 1-2 days
Pneumonia- Hospital-Acquired Pneumonia
Diagnosis: purulent sputum, elevated
leukocytes, fever and new CXR abnormality
Presence of two clinical findings plus
CXR finding significantly increases the
likelihood of ventilator-associated
pneumonia
Bacteremic episodes- infection associated with
indwelling intravascular catheters used for
physiologic monitoring, vascular access, drug
delivery and hyperalimentation
Use of multilumen catheters increase
the risk of infection
Scheduled catheter changes and use of
antibiotic bonded catheters is
associated with lower rates of
colonization
BLOOD BORNE PATHOGENS
HIV transmission from patient to surgeon is
low, higher in nurses
Can be prevented by observation of
UNIVERSAL PRECAUTION
Routine use of barriers (gloves
and goggles)
Washing of hands and other
skin surfaces immediately after
contact with blood or body
fluids
Careful handling and disposal of
sharps instruments
Risk of transmission after needle stick is
0.3%
Post exposure prophylaxes by giving 2
or 3 drug regimen should be initiated
within hours rather than days for the
most effective preventive therapy
Hepatitis B virus (HBV) affects humans only
Hepatitis B immune globulin
confers approximately 75%
protection
Hepatitis C virus previously known as non A non
B
2% incidence after accidental
needle stick
No vaccine yet
Early treatment with INF-
Etiology:
Related to prolonged use of indwelling
tubes and catheters for the purpose of
urinary drainage, ventilation and
venous and arterial access
KEY POINTS:
Incidence of Surgical Site Infections can
be reduced by appropriate patient
preparation, timely perioperative
antibiotic administration, maintenance
of perioperative normothermia and
normoglycemia and appropriate wound
management
Antibiotic prophylaxis
 a. Select an agent with activity against Transmission of HIV and other infections
common organisms at the site of can be minimized by OBSERVATION OF
surgery UNIVERSAL PRECAUTION

b. Initial dose should be given with 30

minutes of incision

c. Antibiotics should be redosed every 1-2

half-lives during surgery to ensure
adequate tissue levels

d. Antibiotics should not be continued for

more than 24 hours after surgery for
routine prophylaxis

Source control is a key concept in the

treatment of most surgical relevant
infections

Outcomes of patient with sepsis are

improved with an organized approach to
therapy that includes rapid resuscitation,
antibiotics and source control

Principles in Antimicrobial Therapy

a. Identify likely source of infection

b. Choose agents that covers likely

organisms for these sources

c. Inadequate or delayed antibiotic

therapy results in increased mortality

d. When possible, obtain cultures early

and use results to tailor therapy

e. If there is no infection identified after 3

days strongly consider discontinuation
of antibiotics

f. Stop antibiotics after an appropriate

course of therapy

Key to good outcomes in patients with

necrotizing soft tissue infection are early
recognition and appropriate debridement/
repeated debridement as necessary