Transcript Clinical Manifestation

Surgical Infection
Dr. Weiguo Hu 胡伟国
Dr. Weihua Qiu 邱伟华
Department of Surgery
Rui Jin Hospital
Shanghai Jiao Tong University School
of Medicine
Key Points：
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Definition
Classifications
Etiology
Clinical Manifestation
Management
Specific Surgical Infections
Characteristics of Hand Infections
Definition：
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Infections be treated by surgical intervention
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Infections following surgical procedure
(wound or distant site)
Classifications：Characteristic
Non-specific infection
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Furuncle & Carbuncle
Cellulitis & Erysipelas
Hand infection
Acute appendicitis
Acute peritonitis
Breast abscess
Classifications：Characteristic
Specific infection
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Tuberculosis
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Fungal infection
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Tetanus
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Gas gangrene
Classifications：Course of Disease
Acute infection (<3w)
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Most non-specific infection
Tetanus
Gas gangrene
Chronic infection (>2M)
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Tuberculosis
Sub-acute infection (3w-2M)
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Urine tract infection
Fungal infection
Classifications：Others
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Opportunistic Infection
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Superinfection
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Nosocomial Infection
Classifications：Others
Local phase
Systemic phase
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Skin infection
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Bacteremia
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Soft-tissue infection
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Sepsis
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Hand infection
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Abscess
Etiology：Pathogenic Microorgansim
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Bacteria
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Endotoxin
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Virus
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Ectotoxin
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Fungi
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Enzyme
Etiology：Local Factors
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Trauma
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Ischemia and Hypoxia
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Obstruction
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Presence of Foreign Bodies and Necrotic
Tissues
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Ionizing Radiation
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Edema
Etiology：Systemic Factors
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Severe Trauma
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DM
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Cancer, Chemotherapy
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Leukemia
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AIDS
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Immunodeficiency
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Malnutrition
Results：Non-specific Infections
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Cure
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Dissemination
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Abscess formation
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Bacteriamia & Sepsis
& SIRS & MODS
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Chronic infection
Results：Specific Infections
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Mixed infection
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Systemic infection
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Tuberculosis
Tetanus, gas gangrene
Opportunistic infection
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Fungi
Clinical Manifestation：
Localized surgical infection
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Redness
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Swelling
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Pain
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Heat
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Loss of function
Clinical Manifestation：
Localized surgical infection
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Fever
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Chills
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Tachycardia
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Leukocytosis & left shift of WBCs
Synergistic Gangrene
caused by streptococci & staphylococci
(self-injection with heroin)
Clinical Manifestation：
Severe Systemic Infection (Gram-positive)
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Chill, Fever
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Flushing
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Warm Extremities
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Metastatic abscess
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Shock in late phase
Clinical Manifestation：
Severe Systemic Infection (Gram-negative)
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Chill, Fever
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Cold Extremities
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Shock in early phase
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Oliguria
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High-output heart failure
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Disturbed sensorium
Diagnosis：
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HPI
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Physical Examination
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General Condition
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Regional Symptoms
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Mal-function of Related Organs
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Characteristic Manifestations
Diagnosis：
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Lab Test
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CBC
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Culture
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Sensitivity Test
Others
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CT
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Ultrasonic
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X-ray
Physical Exam：
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Intravenous cannula---purulent drainage
or thrombophlebitis
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Rectal examination---pelvic abscess
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Auscultation of chest---pneumonia
Physical Exam： Exudate
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Accumulation of extracellular fluid
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Color, odor, character
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Be useful in categorizing the causative organism
Gram stain
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an essential procedure for diagnosis and treatment
Breast abscess
Physical Exam： Biopsy
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Being necessary for diagnosis sometimes
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Especially for granulomatous infection
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Tuberculosis
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blastomycosis
Culture：
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Exudate
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Blood
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the most reliable diagnosis for treatment
Both aerobic and anaerobic culture
Diagnostic step for unknown source
Fail to capture causative organisms in bacteremia
Unnecessary to diagnose sepsis
Sputum
Urine
Management：
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General Supporting
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Temperature Control
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Management of Water and Electrolytes Balance
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Nutrition Supplement
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Hypoalbuminemia
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Uderlying Factors
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Vital Signs Monitor
Management：
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Immobilization of the infection area
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Effective local care
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Relief of swelling & pain
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Proper Dressing
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Physical Therapy
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to increase local blood supply
to facilitate exudation
Management：
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Surgical Therapy
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Debridement of Infected or necrotic tissues
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Harboring foreign objects & microorgnisms
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Poor blood supply
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Decreasing host resistance
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Skin Grafting
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Paracentesis
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Drainage of Abscess
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Removal of Foreign Body
Simple appendicitis treated by early operation
Neglected, perforated appendicitis
with a complex lower abdominal abscess
associated with necrosis of adjacent tissue
Principle of Antibiotics
Management:
Indications:
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Acute sever trauma and infection
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Prophylactic Management
Management：Antibiotics
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Bacteriostatic agents
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Prevent growth of bacteria
Bacteriocidal agents
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Actually kill bacteria
Management：Antibiotics
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Effective agent against the infecting organism
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Adequate contact between agent and organism
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Absence of toxic side effect of the agent
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Augmentation of host defenses to maximize
antibacterial effects
Management：Antibiotics
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Culture before antibiotic therapy
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Administer antibiotics on empiric basis before the
laboratory reports
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Culture and sensitivity test (Evidence basis)
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a combination of antibiotics for probable polymicrobic
infection
Colonization & Superinfection:
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Colonization
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The quantitative appearance of changes in the microflora
that are induced by antibiotic therapy
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Superinfection
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A new microbial disease introduced or potentiated by
antibiotic therapy
Superinfection is frequently the result of colonization.
Antibiotic Prophylaxis
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for potentially contaminated wounds
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Only an adjunct and NOT a substitute to
good surgical technique
Antibiotic Prophylaxis
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Clean procedure
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Clean contaminated procedure
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Contact of the interior of respiratory, urinary,GI tracts
Contaminated procedure
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no antibiotics are necessary
Complicated by gross spillage of intestinal contents or
wounds secondary to trauma
Dirty wounds
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In contact with intraabdominal or perirectal abscess
Antibiotic Prophylaxis
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Malnourished
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Obese
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Elderly
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Immunodeficient
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Shock or MOF
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Poor blood supply to the operative region
Antibiotic Prophylaxis
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early and enough for adequate tissue and body
fluid levels
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Being necessary to maintain adequate tissue
levels intra-operatively
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length of operation and serum half-life of
antibiotics
Cellular site of inhibition Bacteriocidal
Cell wall synthesis
Barrier function of cell
membrane
penicillin
cephalosporins
vancomycin
amphotericin B
Bacteriostatic
nystatin
polymyxin
Protein synthesis in ribosome aminoglycosides
tetracycline
chloramphenicol
Erythromycin
clindamycin
DNA replication
Griseofulvin
Thanks!
Definition：
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Being best treated by
operative intervention
Being following surgical
procedure
(wound or distant site)
Clinical Manifestation：
Localized surgical infection
Superficial wound infection
due to hemolytic Streptococci