WOUND INFECTION

COLLEGE OF DENTISTRY
2012-2013
GENERAL PATHOLOGY
 HISTORY
WINE &VINEGAR;USED AS ANTISEPTIC TO CLEAN
THE WOUNDS.
MAGIC BULLET:IT IS THE CONCEPT OF PRODUCTIO
-N OF A CHEMICAL WHICH KILLS MICRORGANISM
CELL AND SPARING THE AFFECTED HUMAN CELLS.
FIRST ANTIMICROBIAL DISCOVERED IS SULPHANA-
MIDES,THEN PENICILLINS.
INSPITE OF GREAT ANTIMICROBIALS MANUFACTU-
RED ,SOME BACTERIA PRODUCING SPECIAL ENZY-
ME THAT DESTROY THE ANTIMICROBIALS.
 CONT,D
MOST OF ANTIMICROBIALS HAVE BETA LACT-
AM RING WHICH IS DESTROYED BY AN ENZYME
CALLED BETA LACTAMASE PRODUCED BY SOME
BACTERIA.
TO PREVENT INFECTION BETTER THAN TO TREAT IT
i.e. PROPHYLAXIS.
1-ASEPTIC TECHNIQUES.
2-ANTIBIOTICS PROPHYLAXIS ,BEFORE ,DURING AND
AFTER SURGERY.
3-DELAYED CLOSURE OF A CONTAMINATED WOUND
IS A SAFE VALVE TO PREVENT INFECTION.
 BODY RESISTANCE TO INFECTION
--MECHANICAL:SKIN,MUCOUS MEMBRANE INTIGRITY.
--CHEMICAL:LIKE ACIDITY IN THE STOMACH.
SKIN SECRAETIONS TO KILL SOME ORGANISMS.
---HUMORAL:OPSONIN,COMPLEMENT SUBSTANCE.
---CELLULAR:MACROPHAGE,POLYMORPHS.
 WOUND INFECTION
DEFINTION:IT IS INVASION OF MICRORGANISM THR-
OUGH TISSUE AFTER BREAKDOWN OF LOCAL AND/
OR SYSTEMIC HOST DEFENCE ,WITH PRODUCTION
OF LOCAL INFLAMMATORY REACTION.
WOUND INFECTION COULD BE AT THE TIME OF INJU-
RY OR LATER ON.IT DEPENDS ON HOST RESISTANCE,
AND VIRULENCE OF THE MICRORGANISM.
 PATHOLOGICAL &
CLINICAL CONDITIONS RELATED TO INFECTION
INFECTION:LOCAL INFLAMMATION DUE TO INVASION
OF VIRULENT MICRORGANISM.
SEPSIS:IT IS LOCAL INFECTION + SYSTEMIC MANIFEST-
ATIONS SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME (SIRS).
SIRS WHEN 2 OR MORE OF THE FOLLOWINGS PRESENT:
-TEMPERATURE=MORE THAN 38 OR LESS THAN 36
DEGREE CENTIGRADE.
-W.B.C. MORE THAN 12,000 OR LESS THAN 4,000.
 CONT,D
PULSE RATE:MORE THAN 90/MINT.
RESPIRATORY RATE:MORE THAN 20/MINT.
THE PATHOGENESIS OF SIRS IS REALEASE OF CYTOKIN-
ES (INTERLEUKINS,TUMOR NECROSIS FACTOR -TNF) FROM
MACROPHAGES AND NEUTROPHILS.
SIRS COULD BE SEEN IN MULTIPLE TRAUMA,BURN,
ACUTE PANCREATITIS,IN ADDITION TO SEPSIS .
SEVER SEPSIS:SEPSIS+ MODS(MULTIPLE ORGAN
DYSFUNCTION SYNDROME),ONE OR MORE ORGAN
DYSFUNCTION.LIKE ARDS (ACUTE RESPIRATORY
SYNDROME),,RENAL(ACUTE TUBULAR NECROSIS), HEPATIC
(COAGULATION ABNORMALITY&HYPERBILIRUBINAEMIA).
AGAIN THESE EFFECTS DUE TO RELEASE OF INTERLEUKINS&TNF.
 CONT,D
SEPTIC SHOCK:SEVER SEPSIS + HYPOTENSION AND
END IN MSOF(MULTIPLE SYSTEMIC ORGAN FAILURE).
DEFINITION OF INFECTED STATES IN SUMMARY:
SSSI :IT IS WOUND INFECTION.
SIRS :BODY SYSTEMIC RESPONSE TO INFECTION.
MODS:EFFECT OF INFECTION ON WHOLE BODY .
MSOF: END STAGE OF UNCONTROLLED MODS.
 RISK FACTORS INCREASING RISK OF INFECTION
LOCAL FACTORS:
1-POOR BLOOD FLOW LIKE ATHEROSCLEROSIS.
2-FOREIGN BODY.
3-POOR SURGICAL TECHNIQUE:DEAD SPACE,HAEMATOMA,TOO
MUCH DISSECTION WITH
DEVASCULARISATION.
GENERAL FACTORS:
1-AGE .
2- MALNUTRITION.OBESITY,HYPOPROTEINAEMIA,ANAEMIA.
3-METABOLLIC:URAEMIA,JAUNDICE,DIABETIS MELLITUS.
4-IMMUNE
DEFCIENCY:AIDS,CANCER,CHEMOTHERAPY,RADIOTHERAPY
OR STEROIDS THERAPY.
 OPPORTUNISTIC INFECTION
IT IS INFECTION BY AVIRULENT MICRORGANISM,WH-
EN THE BODY RESISTANCE ,OR DEFENCE SYSTEM,
IS COMPROMISED ,OR BROKEN AS IN SEVER BURN,
AIDS,OR PATIENT ON IMMUNOSUPPRESSION
THERAPY(RENAL TRANSPLANT),STEROIDS OR
CHEMOTHERAPY.
 RATES OF SURGICAL WOUND INFECTION
TYPES OF WOUNDS ACCORDING TO THE RATES OF
INFECTION:
1- CLEAN WOUND:LIKE HERNIA SURGERY,THYROID,
BREAST SURGERY RATE OF INFECTION 1%-2% .
2-CLEAN CONTAMINATED:LIKE CHOLECYSTECTOMY,
ORAL CAVITY,GASTRIC SURGERY,BOWEL SURGERY.
RATE OF INFECTION LESS THAN 10% .
3-CONTAMINATED:APPENDICECTOMY, DIVERTICULITIS
RATE OF INFECTION 15%-20%
4-DIRTY WOUND: PUS DRAINAGE IN PERFORATED
APPENDICITIS,APPENDICULAR ABSCESS,APICAL ABSCESS.
RATE OF INFECTION IS LESS THAN 40% .
 SOURCE OF INFECTION
1-PRIMARYENDOGENOUS FROM THE PATIENT OR
COMMUNITY ACQUIRED.
2-SECONDARYHOSPITAL ACQUIREDNOSOCOMIAL
INFECTION-FROM THE THEATRE OR THE WARD.
 SURGICAL SITE INFECTION
SUPERFICIAL SURGICAL SITE INFECTION:
SKIN & SUBCUTANEOUS TISSUE.

DEEP SURGICAL SITE INFECTION:

MUSCLE & FASCIA.

ORGAN OR SPACE SURGICAL SITE INFECTION:

ABDOMINAL OR THORACIC
(COELOMIC CAVITY).
SURGICAL SITE INFECTION (SSI )

SSSI
 SURGICAL WOUND INFECTION
OTHER CLASSIFICATION OF SURGICAL SITE INFECTION,
(SSI) :
MINOR INFECTION-SIMPLE INFECTION WITHOUT SIRS.
AND PATIENT DISCHARGED HOME.
MAJOR INFECTIONINFECTION WITH EXCESS OF PUS,
AND WITH SIRS,AND KEEP PATIENT IN THE HOSPITAL,
FOR FURTHER TREATMENT.
 SURGICAL WOUND INFECTION
MAJOR WOUND INFECTION-TOO MUCH
MINOR WOUND INFECTIONNO,SIRS PUS +SIRS
 TYPES OF INFECTION
1- WOUND ABSCESS.
2- CELLULITIS & LYMPHANGITIS.
3- BACTERAEMIA & SEPTICAEMIA.
4-SPECIFIC WOUND INFECTION :GAS GANGRENE.
 WOUND ABSCESS
IT IS PUS CONTAINING CAVITY .
ACUTE ABSCESS: THE WALL OF THE ABSCESS,
(CALLED PYOGENIC MEMBRANE);IT IS COMPOSED
OF INFLAMMED TISSUE AND FIBRIN ,HEAVILY
INFILTERATED BY POLYMORHS ,MACROPHAGE.
CHRONIC ABSCESS: WHEN THE WALL COMPOSED OF
FIBROUS TISSUE AND HEAVILY INFILTERATED BY,POLY-
MORPHS,MACROPHAGE AND OTHER CHRONIC
INFLAMMATORY CELLS (LYMPHOCYTES&PLASMA
CELLS).
 SURGICAL WOUND INFECTION
WOUND INFECTION-PUS COLLECTION INFECTION WITH CELLULITIS
 WHAT IS PUS,AND PUS CELLS?
PUS IS A FLUID COMPOSED OF :DEAD &DYING WBC,
DEAD &DYING BACTERIA(IN BACTERIAL CAUSE OF
PUS),TISSUE DEBRIS,OEDEMA,FIBRIN,LIPID AND
NUCLEIC ACID.
PUS CELLS :IT IS DEGRANULATED WBC NEUTROPHILS.
ACUTE ABSCESS APPEARS 7-9 DAYS AFTER SURGERY ,
OR TRAUMA.IF NOT DRAINED IT MIGHT RUPTURE,
LEADING TO DISCHARGING SINUS.
CHRONIC ABSCESS:IT IS EITHER FROM ACUTE INFECT
ION AND NOT DRAINED AND PRESENCE OF FOREIGN
BODY OR DEAD TISSUE.IT MIGHT BE FROM THE
START CHRONIC AS IN T.B. & ACTINOMYCOSIS.
 MANAGEMENT OF ABSCESS
DIAGNOSIS:-CLINICAL: PYREXIA,HIGH PULSE,LEUCO-
CYTOSIS.
IMAGING TESTS:U/S,CT SCAN &MRI.
TREATMENT:DRAINGE UNDER COVER OF ANTIBIOTICS
,S.T. ASPIRATION UNDER U/S OR CT GUIDE.
NO, CLOSURE OF ABSCESS CAVITY AFTER DRAINAGE,
LEAVE IT FOR SPONTANEOUS CLOSURE,OTHER WISE,
IT WILL RECURE.
 SURGICAL WOUND ABSCESS
REMOVAL OF STICHESDRAIN ABSCESS-- FOR DELAYED PRIMARY SUTURING
LEAVE IT OPENED OR SECONDARY SUTURING
IMAGING TO DIAGNOSE DEEP ABSCESS
U/S ABSCESS CAVITY SPLENIC ABSCESS SHOWN BY CT SCAN
ASPIRATION OF THE ABSCESS UNDER U/S & CT SCAN
 DRAINAGE OF ABSCESS
DRAINAGE UNDER IMAGING SURGICAL DRAINAGE
 CELLULITIS,LYMPHANGITIS
CELLULITIS:DIFFUSE ,NON-LOCALISED NON-SUPPURAT
ATIVE INFLAMMATION CAUSED BY MICRORGANISMS
THAT PRODUCE ,CERTAIN ENZYMES WITH DIFFUSE
TISSUE DESTRUCTION.THESE ENZMES
ARE,STREPTOKINASE ,HYALURONIDASE & OTHER PRO-
TEASE ENZYMES,LYSING TISSUE BARRIERS.
THE COMMON CAUSATIVE ORGANISM :
BETA-HAEMOLYTIC STREPTOCOCCI.
CLUSTRIDIA PERFERINGENS.
STAPHYLOCOCCI.
THIS CELLULITIS ASSOCIATED WITH SIRS,DUE TO RELEASE
OF CYTOKINES(INTERLEUKINS,TNF),FROM MACROPHAGE
&POLYMORPHS.
 CELLULITS
DIFFUSE NON-LOCALISED
INFLAMMATION NON-SUPPURATIVE INFLAMMATION
 CELLULITIS
FACIAL CELLULITIS ORBITAL CELLULITIS
 LYMPHANGITIS
IT IS NON-LOCALISED DIFFUSE INFLAMMATION OF
LYMPHATIC CHANNELS COMMONLY CAUSED BY
STREPTOCOCCUS PYROGENES (BETA HAEMOLYTIC
STREPTOCOCCI),PRODUCING RED PAINFUL STREAKS
IN THE AFFECTED LYMPHATICS WITH PAINFUL LYMPH
NODE ENLARGEMENT.
 LYMPHANGITIS
RED PAINFUL STREAKS AXILLARY L.N. ENLARGMENT
 OTHER FORM OF INFECTION----
BACTERAEMIA,SEPTICAEMIA,PYAEMIA
DEFINITION:BACTERAEMIA :TRANSIENT PRESENCE OF
BACTERIA IN THE BLOOD CIRCULATION CAUSING FEW
SYMPTOMS,LIKE RIGOR.THAT WHAT HAPPENS AFTER
URINARY BLADDER CATHETERISATION IF SOME INFEC-
TION THERE,OR AFTER EXTRACTION OF TOOTH WHICH HAS
APICAL ABSCEES.BACTERAEMIA EASILY
CONTROLLED BY BODY MPS(MONONUCLEAR PHAGOCYTE
SYSTEM).PATIENT WITH GOOD IMMUNITY.
THE PROBLEM IN THIS CONDITION IS PATIENT WITH
C.H.D.,VALVULAR HEART DISEASE,VALVE REPLACEME-
NT,JOINT REPLACEMENT,SO BACTERIA WILL SETTLE IN THE
HEART PRODUCING SUBACUTE BACTERIAL ENDOC-
CARDITIS ,BY STREPTOCOCCI VIRIDANS OR JOINT INFECTION.
 TYPES OF INFECTIONCONT,D
PYAEMIA:INFECTED THROMBUS CIRCULATING IN THE
BLOOD,PRODUCING METASTATIC ABSCESS.
e.g.;ACUTE APPENDICITIS,INFECTED PILES LEAD
TO PORTAL PAEMIA LEADING TO METASTATIC
LIVER ABSCESS.
ACUTE SUPPURATIVE ARTHRITIS,OR ACUTE
OSTEOMYLITIS MIGHT LEAD TO PYAEMIA WITH
MULTIPLE LUNG ABSCESS.
 CONT,D
SEPTICAEMIA:THE ORGANISM PROLIFERATES &BL-
OOD FLOODED WITH THE ORGANISM AND THE
MPS UNABLE TO DESTROY THEM,SO PATIENT,
GRAVELY ILL ,POOR RESISTANCE WITH SEVER
CONSTITUTIONAL SYMPTOMES LEADING TO SEPTIC
SHOCK AND EVEN TO MSOF(MULTIPLE SYSTEM
ORGAN FAILURE ) LEADING TO IRRIVERSIBLE SHOCK
AND DEATH.MAIN ORGANISMS INVOLVED IN BOTH
BACTERAEMIA & SEPTICAEMIA,GRAM NEGATIVE
AEROBIC INTESTINAL BACILLI,
(E.COLI,PROTEUS,KLIBSIELA,PSUDOMONAS).
STAPHYLOCOCCI,AND FUNGI MIGHT BE INVOLVED.
SEPTICAEMIA OCCURS AFTER BOWEL SURGERY,BURNS.
 WHAT IS THE DIFFERENCE BETWEEN BACTERAEMIA &
SEPTICAEMIA ?
BACTERAEMIA SEPTICAEMIA
 OTHER TYPES OF WOUND INFECTION
SPECIFIC WOUND INFECTION;
GAS GANGRENE:IT IS INFECTION BY GRAM POSITIVE ANAEROBIC
SPORE-FORMING BACILLI,(CL.PERFRINGENS),
DUE TO CONTAMINATION OF THE WOUNDS BY FAECES,OR
SOILS,COMMONLY SEEN DURING WAR
AND TRAUMATIC SURGERY,PARTICULARLY IN ATHEROSCLROSIS LIMBS OR
CLOSED DIRTY WOUNDS (ANAEROBIC ENVIROMENT),SO NEVER
CLOSE THE WOUND.ALSO DIABETICS,OR IMMUNOCOMPROMISED ARE AT
HIGH RISK.AMPUTATED LIMB IN ATHEROSCLEROSIS IS AT RISK.
THE CHARACTERISTICS OF THE WOUND IS PAINFUL
WITH CREPITUS DUE TO GAS WHICH SEEN BY X-RAY
BROWN SWEET SMELLING EXUDATE WITH OEDEMATOUS,
SPREADING GANGRENE,PATIENT WITH CIRCULATORY COLLAPSE,
SEPTIC SHOCK & MSOF.
ACUTE HAEMOLYTIC ANAEMIA DUE TO ALPHA TOXINS.
TREATMENT:EXTENSIVE AGGRESSIVE WOUND EXCISION WITH HEAVY DOSE
OF PENICILLIN.
 CLOSTRIDIUM PERFRENGENS
GRAM POSITIVE ANAEROBS WITH SPORES SUBTERMINAL SPORES
 GAS GANGRENE
BLISTER WITH GAS FORMING BACTERIA ATHEROSCLEROTIC AMPUTATED LIMB
 OTHER INFECTION BY CLOSTREDIA
TETANUS :CAUSED BY CLOSTRIDIA TETANTI,GRAM
POSITIVE ANAEROBIC,SPORFORMING BACILLI,HAVE
THE EFFECT DISTANT FROM THE WOUND BY 2
EXOTOXINS:TETANOSPASMIN ATTACK CNS,TETANO
LYSIN TO HAEMOLYSE RBC .
IT CAUSES NEUROLOGICAL DISORDER LIKE
OPISTHOTONUS,RISUS SARDONICUS,RESPIRATORY
FAILURE IS THE MAIN CAUSE OF DEATH.
PROPHYLAXIS :TOXOID VACCINATION,AND GAMMA
GLOBULIN THERAPY.
CLOSTRIDIUM TETANI-DRUM STICK LIKE BACILLI
 TETANUS
FACIAL & BODY MUSCLE TONIC
CONTRACTION RISUS SARDONICUS
OPISTHOTONUS-TONIC CONTRACTION OF THE
MUSCLES OF THE BACK
 OTHER INFECTIONSYNERGISTIC SPREADING
GANGRENE
IT IS AN INFECTION CAUSED BY MIXED ORGANISM
ACTING
SYNERGISTCALLY,STAPHYLOCOCI,ANAEROBIC
STREPTOCOCCI,BACTEROIDS,&COLIFORM,PRODUCI-
NG DIFFUSE GANGERNOUS ABDOMINAL WALL,
PARTICULARLY AFTER PERITONITIS DRAINAGE,
ASSOCIATED WITH CIRCULATORY COLLAPSE,AND
EVEN MSOF IT IS ALSO CALLED ,NECROTISING FASC-
IT IS ,(MELENY,S SYNERGISTIC GANGRENE ).
TREATMENT:CIRCULATORY SUPPORT +WIDE LOCAL
EXCISION + ANTIBIOTICS .
SYNERGISTIC GANGRENE
CONCRUM ORISGANGRENOUS STOMATITIS-SYNERGISTIC
INFECTION-OPPORTUNISTIC INFECTION-LEUKAMIA
A WOUND BECOMES INFECTED OR NOT DEPENDS ON
1-VIRULENCE OF THE MICRORGANISM.
2-DOSE OF THE MICRORGANISM.
3-VASCULARITY OF THE TISSUE INVADED.
4-HEALTH OF THE TISSUE INVADED.
5-PRESENCE OF DEAD TISSUE OR FOREIGN BODY.
6-GENERAL HOST DEFENCE SYSTEM.
7-USE OF PROPHYLACTIC ANTIBIOTICS.
PROPHYLACTIC ANTIBIOTIC SHOULD BE GIVEN PREO-
PERATIVELY OR AT THE TIME OF CUTTING AS THE
BACTERIA INVADES THE BODY AND THE HOST NEEDS 4
HOURS (DECISIVE PERIOD) TO DEFEND(HUMORAL
&CELLULAR RESISTANCE),SO ANTIBIOTIC SHOULD BE
GIVEN AT THE TIME MENTIONED ABOVE.
 PYOGENIC INFECTION
INFECTION BY MICRORGANISM WITH PUS FORMATION
OR SUPPURATION.
COMMONEST ORGANISMS INVOLVED IN WOUND
INFECTION ARE:STAPHYLOCOCCI,STREPTOCOCCI,GRAM
NEGATIVE AEROBIC INTESTINAL BACILLI
(E.COLI,PROTEUS, KLEBSIELA,PSEUDOMONAS) AND
ANAEROBIC GRAM NEGATIVE INTESTINAL BACILLI
BACTEROIDS.
WHEN MICRORGANISM INVADES THE WOUND,LEADS
TO ACUTE INFLAMMATION---RESOLUTION,IF
NOT,SUPPURATION,IF NOT DRAINED DISCHARGING
SINUS.IF NOT RESOLVED ---CHRONIC INFLAMMATION,
LIKE CHRONIC CHOLECYSTITIS,CHRONIC OSTEOMYLITIS.
 GENERAL BODY RESPONSE TO INFECTION
--PYREXIA.
---RAPID PULSE.
---LOSS OF WEIGHT.
--- INCREASE OF W.B.C. COUNT.
----HIGH ESR.
 GENERAL TREATMENT OF WOUND INFECTION
IN MINOR WOUND INFECTION,NO,WORRY SEND
PATIENT HOME.
IN MAJOR WOUND INFECTION WITH PUS
COLLECTION:REMOVE THE STICHES,DRAIN THE
ABSCESS,SWAB THE PUS,SEND FOR CULTURE &
SENSITIVITY TEST FOR AEROBIC &ANAEROBIC MIC-
RORGANISM,MEAN WHILE START EMPERICAL
ANTIBIOTICS WHILE WAITING FOR THE RESULT OF
C&S TEST.IF PATIENT IMPROVING KEEP ON THE
ANTIBIOTIC ALREADY STARTED,IF NO,IMPROVEMENT
SHIFT TO THE RESULT OF C& S TEST.
ANY ABSCESS SHOULD BE DRAINED AND LEFT
OPENED,TILL CLEARANCE THEN IF NOT CLOSED
SPONTANEOUSLY,DO DELAYED PRIMARY SUTURING(4-6
DAYS).OR SECONDARY SUTURING (10-14 DAYS.) .
 BACTERIA INVOLVED IN WOUND INFECTION
STREPTOCOCCI:GRAM POSITIVE AEROBIC COCCI.
Streptococcus pyogens---CELLULITIS.
Streptococcus faecalis---ENTEROCOCCI,INVOLV-
ED IN WOUND INFECTION AFTER BOWEL SURGERY.
Streptococcus viridans---SUBACUTE BACTERIAL
ENDOCARDITIS AFTER BACTERAEMIA.
SENSITIVE TO PENICILLIN & ITS DERIVITIVES.
SENSITIVE TO AMPICILLIN, & AMOXOCILLIN.
 STREPTOCOCCI
STREPTOCOCCICHAIN COCCI CELLULITIS
BACTERIA INVOLVED IN WOUND INFECTION-CONT,D
STAPHYLOCOCCI :GRAM POSITIVE,AEROBIC COCCI.IN
FORM OF CLUSTERS.COMMONEST CAUSE OF SURGIC-
AL WOUND INFECTION PRODUCING LOCALIZED PUS
FORMATION.
Staphylococcus aureus :COAGULASE POSITIVE, IT
MEANS PRODUCING ENZYME TO MAKE THE INFECTI-
ON ,MORE LOCALISE BY FIBRIN FORMATION.
THESE BACTERIA PRODUCING BETA LACTAMASE ,
WHICH DESTROYS THE BETA RING OF PENICILLIN SUB-
STANCE.
IT IS SENSITIVE TO :FLUCLOXACILLIN,VANCOMYCIN,AMIN-
OGLYCOSIDES(GENTAMYCIN),THIRD GENERATION CEPHA-
LOSPORINS(CEFATOXIME & CEFATRIOXONE).
 STAPHYLOCOCCI
CLUSTERS OF STAPH STAPHYLOCOCCAL WOUND INFECTION
 WHAT IS MRSA ?
IT IS TYPE OF STAPHYLOCOCCI RESISTANCE TO ANTI-
BIOTIC METHICILLIN AND HAVE THE ABILITY TO PROD
UCE EPIDEMIC INFECTION SPREDING IN THE HOSPITAL
AND IT IS SENSITIVE TO ANTIBIOTIC VANCOMYCIN.
WHAT IS VRSA?
IT IS VANCOMYCIN RESISTANT Staphylococcus aureus
AGAIN PRODUCING SPREADING HOSPITAL INFECTION
BUT SENSITIVE TO TEICOPLANIN AND LINEOZOLID
ANTIBIOTICS.
 OTHER BACTERIA PRODUCING WOUND
CLOSTREDIA; INFECTION
Clostridium perfrengens; GRAM POSITIVE SPORE FORM-
ING ANAEROBIC BACILLI CAUSING GAS GANGRENE.
PENICILLINE OR METRONIDAZOLE ANTIMICROBIALS.
Clostridium tetani:CAUSING TETANUS.
Clostridium difficile:CAUSING PSEUDOMEMBRANOUS
COLITIS WITH SEVER DIARRHEA AS ARESULT OF LONG
USAGE OF SPECIAL ANTIBIOTICS LIKE CLINDAMYCIN,
& LINCOCIN.TREAMENT VANCOMYCIN,OR
METRONIDAZOLE(FLAGYL).
 GRAM NEGATIVE INTESTINAL BACILLI
THESE NORMAL BOWEL INHABITANTS.
AEROBIC GROUP:
E.COLI,PROTEUS,KLEBSIELA,PSEUDOMONAS.
ANAEROBIC GROUP:
BACTEROIDS;IT PRODUCES FOUL ODOR PUS,TYPICAL
ANEROBIC INFECTION.
AEROBIC+ANAEROBIC=MIXED PRODUCING WOUND
INFECTION AFTER BOWEL SURGERY,LIKE
APPENDICECTOMY,DIVERTICULITIS,PERITONITIS.
PSEUDOMONAS IS IMPORTANT IN BURN
INFECTION,AND SEPTICAEMIA.ALSO INFECTION OF
TRACHEOSTOMY.
 GRAM NEGATIVE INTESTINAL BACILLI
THE AEROBIC GROUP SENSITIVE TO THE
ANTIBIOTICS;
AMINOGLYCOSIDES(GENTAMYCIN),SECOND
GENERATION CEPHALOSPORINS(CEFAFUROXIME),
QUINOLONES (CIPROFLUXACIN).
CARABPENEM(MEROPENEM).
PSEUDOMONAS:ARE RESISTANT BACTERIA BUT
STILL SENSITIVE TO
:AZLOCILLIN,CEFTAZIDIME(THIRD GEN-
ERATION CEPHALOSPORINS). TAZOCIN INJECTION:
TAZOBACTAM +PIPERACILLIN.
 SURGICAL WOUND INFECTION AFTER BOWEL
SURGERY
THE WOUND OPENED TO DRAIN THE BURST ABDOMEN AFTER BOWEL SURGERY
PUS COLLECTION INFECTION
 BACTERIA INVOLVED IN WOUND INFECTION
& ANTIBIOTICS AFFECTING THEMCONT,D
LACTMASE PRODUCING BACTERIA RESISTANCE TO
AMOXYCILLIN & AMPICILLIN BUT SENSITIVE TO
COMBINATION OF AMOXYCILLIN +CLAVULANIC ACID
PRODUCING AUGMENTIN WHICH IS VERY EFFECTIVE
AGAINST E.COLI,KLEBSIELA,STAPHYLOCOCCI.
VERY USEFUL IN BITES WOUNDS (ANIMAL OR
HUMAN).
BACTEROIDS:VERY SENSITIVE TO METRONIDAZOLE
(FLAGYL),THIRD GENERATION CEPHALOSPORIN (CL-
AFORAN).MEROPENEM,TAZOCIN.
 IN INFECTION DUE TO COMBINED MICRO
ORGANISM
IN COLORECTAL SURGERY,SEVER ORAL CAVITY INFECT-
ION,GYNAECOLOGICAL SURGERY.
THE ORGANISMS RESPONSIBLE ARE E.COLI,PROTEUS,
KLEBSIELA,AND BACTEROIDS SO WE GIVE:
GENTAMYCIN+FLAGYL .
OR CEFAFUROXIME+FLAGYL.
OR MEROPENEM ALONE ,TAZOCIN ALONE OR COMB-
INED WITH FLAGYL.
QUINOLONES (CLINAFLOXACIN,SITAFLOXACIN).
LINCOCIN.