Acute and chronic specific surgical infection

Characteristics and types of surgical infection

The term "surgical infection" is determined by the type, usually, purulent infection, which is caused by penetration of pathological micro-organism in tissues, and often without any surgical methods cannot be cured. This primarily refers to purulent infection.

The reasons for the development of an abscess

The main factors that influence the development of infection are the following factors:

Infectious agent

Local surgical infection may occur due to the impact of many different pathogenic microorganisms, including potential pathogens, the activity and the negative consequences which the development of surgery increase. The entry of infection, in this case, is directly surgery. This is mainly due to the fact that:

1. Surgery proceeds to more complex and demanding job, and becoming more invasive (prolonged surgery, transplantation, implantation, extensive wounds, the solution of complex malformations).
2. Progress in medicine led to widespread use of immunosuppressants, antibiotics and chemotherapy.
3. Surgery is moving towards more and more complex operations, which are often shown older patients.
4. The important role played by the extent of development of society involving the migration of patients, diseases, transport development, transport and the increase of accidents in the workplace.

The susceptibility of a particular person

Sensitivity is defined as the violation of the natural immunity of the body, for various reasons, which can be extensive cancer, diabetes, and many other factors.

Enclosed space

In addition to the enclosed space of the an associate a negative factor affecting the incidence of inflammation in surgery and tissue in violation of vitality. Acute purulent surgical infection, in that case, is growing rapidly, especially in the area of inadequate perfusion, or in the natural cavities of the humanbody with a narrow outlet (Appendix, gall bladder, urinary system), spread of infection in the surgical wound is supported and foreign material (stones, joints, parasites).

The spread of surgical infections and infection in surgery

Surgical infection acute and chronic may spread:

1. The spread of the inflammation through the lymphatic system is specific for streptococcal and staphylococcal infections, has a distinctive and characteristic symptoms and on the surface of the body, accompanied by swelling of the local lymph nodes.
2. The spread of microorganisms hematogenous route, which leads to the formation of so-called infectious distant metastasis.
3. "Per continuitatem" as superficial infection:

• Cellulitis – a flat spread of microorganisms in the subcutaneous connective tissue.
• Abscess – pus-filled cavity bounded purulent membrane.
• Empyema – accumulation of pus in preformed cavities of the human body (empyema of the gall bladder, empyema of the chest). Specific form this group infection is a necrotizing infection that spreads through the anatomically defined structures, such as necrotizing fasciitis.

Classification of surgical infection

Surgical infection can be divided into 2 types:

1. Acute surgical infection.
2. Chronic surgical infection (or chronic specific surgical infection).

   

These 2 types differ in the duration and brightness of the manifestations of the clinical picture.

Superficial infection at the site of surgical intervention

• Infection occurs within 30 days after surgery.
• The infection affects only part of the skin and subcutaneous tissue.
• There are purulent discharge from the superficial incision.
• Is present, at least one of the symptoms of infection: pain, sensitivity, localized swelling, redness, increased skin temperature around the wound.

Deep infection in the surgical intervention

• Infection occurs within 30 days after surgery or up to 1 year in case of implant placement.
• Infection involves deep soft tissue.
• There are purulent discharge from deep incision but not from the organ area.
• Is present least one of the following characteristics: the temperature is about 38°C, localized pain (under the pressure) sensitivity.

Infection organ/cavity in place of a surgical intervention

• Infection occurs within 30 days after surgery or up to 1 year in case of implant placement.
• The infection affects any other anatomical parts than those that were open during surgical interventions, or those with whom they conducted the manipulation.
• The presence of purulent discharge from the drain, which is located in the body/organ.
• Abscess or other signs of infection of the organ cavity, which has been detected in the course of the study, during re-operation, histological or radiological examination.

Views

Early postoperative infection

Any surgical wound is contaminated to a certain extent. Depending on the degree of contamination in surgery wounds are evaluated as:

1. Clean wounds where there is little risk for the development of exogenous or endogenous contamination of the post – operative hernia, surgery varicose veins, etc.
2. Relatively clean (contaminated) wounds are characterized by a mainly endogenous contamination (conditions after surgeries of gallbladder, Appendix, no visible inflammation of these organs).
3. Contaminated wounds – where there are conditions for the source of contamination mainly contents (operations on unprepared bowel, urinary tract).
4. Infected or heavily contaminated wounds that initially struck by the extensive infection (peritonitis, thoracic empyema, abscess).

Late surgical infections

Infection of the respiratory tract, gastrointestinal tract, urinary tract, phlebitis, bedsores, infection of implants.

Boil

The boil is the incidence of infection of the hair follicle, may appear in one place, but also have extensive localization.

Carbuncle

Carbuncle is a combination of multiple abscesses under the skin.

Hydradenitis

We are talking about inflammation of the sweat glands in the armpits, groin or perianal region.

Erysipelas

Erysipelas is a streptococcal skin disease with typical local and somatic complaints.

Erysipeloid

It is an infectious disease Erysipelothrix rhusopathiae typical transmission during processing of fresh meat, especially pork.

Clostridia infection

The most famous and the most dangerous of this group is tetanus infection, but there are many other clostridial infections caused, in particular cellulitis.

Panaritium

Most often, we are talking about a staph infection in the fingers and palm.

Paronychia

Paronychia is ainfection near the nail bed.

Signs of surgical infections

Signs of surgical infections, in addition to the well-known symptoms, such as: rubor and the tumor, distinctive and local symptoms due to the impact in certain locations. Common symptoms include signs of exposure to infectious agents, and lack of wound healing. Wound infections occur as a result of inflammation, which are abnormal tangles of infectious tissue. In addition, any infection suppresses the body's resistance to other infections, because, in fact, acts immunosuppressive. System symptom complex of infection is sepsis and, as a consequence, septic shock.

Diagnostics

Diagnosis of surgical infections is guided by the following criteria:

1. Clinical signs, which always depend on the severity of the condition. They presented General weakness of the person, fatigue, fever, chills, thirst, muscle and joint pain, mental changes, apathy, and aggression, and complete exhaustion.
2. The results of imaging techniques such as radiographs, computed tomography (CT), ultrasonography (us), angiography, magnetic resonance imaging (MRI), radioisotope techniques, diagnostic puncture.
3. The results of the diagnostic operations. Surgery is now rarely used diagnostic methods in surgery and is only recommended in uncertain and urgent circumstances.
4. Histological and pathological-ANATOMICHESKOE studies, as well as a traditional biopsy.
5. The results of laboratory tests:

• hematological changes in white blood components (not only leukocytes, but also leukopenia and thrombocytopenia),
• biochemical – basically, study of acute phase proteins – C-reactive protein, immunoglobulins, changes mineralogramma, liver function,
• microbiological – most accurately based on the study of culture,
• serological and immunological – these tests are rarely used in surgery and, in particular, when certain complex and rare infections,
• radioimmunoassays – designed for specific identification of specific mediators.

Treatment of surgical infections

Surgical treatment may be:

Surgical

Deletion, which applies the well-known rule "ubi pus ibi evacua" (removal of pus).

Antimicrobial chemotherapy and antibiotic therapy

These methods are the following methods of surgical treatment of abscesses, always presenting a part of the surgical treatment. The method is guided by the availability of drugs, tolerance of the patient to drugs and resistance of pathogens.

When selecting chemotherapy or antibacterial drug, it is important to consider the ability of penetration of antibiotics in different types of fabric.

Antibiotics are divided into bactericidal and bacteriostatic, but in the treatment of surgical infections, first and foremost, the choice of stops on the bactericidal antibiotics. Proper treatment with antibiotics should be adjusted in accordance with MIC – minimal inhibition concentration (minimum concentration inhibition), which is the lowest concentration of antibiotics acting on the corresponding type of the pathogen.

With antibiotic treatment you should always remember about the possible toxicity of the various components of the drug and their affinities to various tissues of the body that actually determines the route of administration of antibiotics.

When antibiotic therapy it is necessary to pay attention to the dosage in children and in violation of renal function – with reduced excretion of the antibiotic and its derivatives accumulate in the body. There are special rules governing the use of antibiotics during pregnancy.

It is further important interaction of antibiotics.

Antibiotic prophylaxis, especially important to prevent inflammation in the surgical wound. She can be single, but introduced in stages, at different times before surgery.

Immunotherapy

The most obvious example of such treatment is the prevention and treatment of tetanus, but in other surgical infections, this method is not applicable, such treatment is ineffective. In addition to specific immunotherapy, it is preferred to maintain innate immunity, nourishing the tissues with oxygen, intake of vitamin C as a liquidator of excess oxygen radicals and other auxiliary substances.

Pharmacotherapy

Taking painkillers, anticoagulants, drugs to maintain circulation. The use of corticosteroids remains controversial, their positive effect is not clearly proven.

Other treatment options:

• Physical rest, General and local.
• Local application of heat speeds up the ripening of inflammation.
• Cold reduces pain and slows down the development of inflammation.
• Hyperbaric oxygen therapy – suitable for anaerobic infections.
• Local antiseptic effect.

Etiology

Damage to the skin modifies its abilityto act as an antibacterial barrier. The balance that exists between micro-organisms, the protective powers of man and the environment collapses and can cause skin inflammation. Loss of balance between the microorganisms, the protective forces of the organism and the environment is more likely to occur if there is too high a dose of the bacteria or the body's defenses are disrupted by malnutrition or use of certain types of pharmaceuticals. Other important factors are the level of contamination and virulence of the microorganism. Directly, the development of surgical inflammation precedes microbial contamination of a specific area of the body.

It was quantitatively confirmed that the risk of infection increases significantly when pollution wounds more than 105 microorganisms per 1 g tissue. The dose of contaminating microorganisms required for infection may be much lower if there is a foreign microorganism, for example, 100stafilokokkov on 1 g of fabric, touching the seams. The organisms causing surgical infection, represented mainly gram-positive cocci, mainly originating from human skin. Infection can be caused by other microorganisms, including the commensals. Almost every organism has the potential to cause abscess, when there is an imbalance between the number of bacteria and the protective forces of the body.

The most common isolated microorganisms that cause surgical infection include:

• golden staphilococcus,
• coagulasenegative aureus,
• enterococcus,
• colon bacillus,
• blue pus bacillus,
• enterobacteria etc.

External sources of microorganisms that cause infection include:

• the surgical staff,
• the environment of the operating theatre,
• equipment and materials brought to the sterile field during surgery.

The number of microorganisms contaminating a wound, is directly related to morbidity.

The resistance of the human body depends on his clinical condition before surgery.

The increased risk of infection, in addition to colonization of microorganisms and weakening of the immune response, also depends on the following factors:

• age,
• nutritional status (malnutrition),
• diabetes,
• smoking,
• obesity,
• more primary diagnoses,
• regular use of steroids,
• coexisting infection at a remote body site,
• the duration of preoperative hospitalization.

Look at nosocomial infection in surgical patients
Etiopathogenesis increasingly exposed to a broad spectrum of microorganisms. They are able to Express their infectious activity in the changed conditions of organisms and immunosuppression.

In many cases, infection occurs due to the synergetic action of several microorganisms, which are reflected in this complex as pathogenic. To explain microbial synergism was proposed several hypotheses. If this phenomenon comes in a mixed aerobic and anaerobic flora, it can be initiated by mutual protection from phagocytosis and intracellular destruction of microorganisms, the production of major growth factors and reducing the redox potential in the tissues. In this situation, the physical conditions preferred for replication and invasion components of anaerobic infection.

Prevention

Methods of reducing morbidity can be divided into:

1. Preoperative.
2. Intraoperative.
3. Postoperative.

Preoperative prophylaxis

1. The shortest hospitalization before surgery.
2. Preoperative antiseptic shower reduces the microbial colonization of the skin to 9 times to achieve maximum antimicrobial activity shower is recommended to repeat several times.
3. When the planned interventions required the treatment of various other infections.
4. Preoperative shaving of the surgical site with a razor is associated with significantly higher risk of infection than shaving with clippers or depilatory agents. Some studies even suggest the possibility of hair removal in certain circumstances, to refuse. An increased risk of developing wound infections due to the microscopic wounds the skin in which bacteria can settle and multiply.
5. Antibiotic prophylaxis involves the use of certain antimicrobial drugs to reduce morbidity. The goal of this therapy is to achieve and maintain effective concentration of the selected antibiotic in the tissues of the surgical field throughout the procedure and in the period immediately after. Should take into account that the use of antibacterial prophylaxis is not a substitute for aseptic conditions and adequate preparation of the patient.

Intraoperative prevention

1. You must use all measures of asepsis and barrier methods of care.
2. Members of the surgical team who have direct contact with the sterile operatingfield or sterile instruments and supplies used in the surgical area, before the operation to decontaminate hands, wear a sterile gown and gloves.
3. The surgical team, including the anesthesiologist, when entering the operating room wear a mask that completely covers the mouth and nose, to have her face throughout the operation, the surgical cap must cover the entire hair.
4. Surgical gowns must be consistent with applicable legislation (to prevent the penetration of liquids and microorganisms). If the economic situation allows the medical device, it is advantageous to use disposable robes and masks.
5. Important proper preparation of the skin of the patient in the operating room, especially, compliance with the exposure time of the disinfectant and the beginning of the operation only after it dries. Antiseptic is applied to the circles, starting with the contemplated incision.

Postoperative prevention

1. The cut, which was initially closed, must be covered with a sterile bandage, which must be present on the wound within 24 to 48 hours after surgery.
2. It is important to adhere to the principles of antiseptic dressing, and when in any contact with the surgical site.
3. When dressing, use sterile materials and instruments.
4. At discharge the patient home, it is necessary for him and his family members to inform you about the proper care of the wound, the symptoms of the infection and the need to immediately report these signs.