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Surgical Infection History Lister: 1867 On the antiseptic principle in practice of surgery Louis Pasteur, Ignaz Semmelweis, Theodor Kocher and William S. Halsted Application of antiseptic practices allowed infection rate of operation to drop from 90% to 10%. History Antibiotics: introduced in the middle of 20th century Hope serious surgical infection eliminated, but this did not occur. Nosocomial infection, widespread antibiotics therapy New techniques: endoprosthesis, transplantation requires immunosuppressive agents, et al. Definition The infection required operative intervention, including that complicated from trauma, operation and burns, et al. Caused by the invasion, resident and proliferation of pathogens, such as bacteria, viruses and fungi et al. Classification: Pathogenesis: Non-specific infection: suppurative infection presentation: redness, swelling, hot, soreness pathogens: Staphylococci aureus, Streptococci. Specific infection: tuberculosis, tetanus, gas gangrene, fungi Classification procession: acute subacute chronic Classification Source of pathogens: Primary Secondary Exogenous Endogenous Classification Opportunity: Opportunistic Superinfection Nosocomial infection Etiology Causes of surgical infection: normal bacterial flora---pathogenic bacteria exogenous bacteria low host resistance Etiology Bacteria factors: adherence toxins: exotoxin, endotoxin numbers of bacteria: 105 Etiology Local factors: injury of skin or mucosa duct obstruction blood supply skin or mucosa diseases Etiology Systemic factors: severe disease hormone malnutrition AIDS Pathology Non-specific infection: bacteria proliferation leucocyte infiltration inflammatory media and cytokines release congestion, excudation accumulation of serum, blood cells, necrotic tissues redness, swelling, hot and soreness, and dysfunction. Pathology results: alleviate suppurative to spread to be chronic Pathology Specific infection: tuberculosis tetanus gas gangrene fungi infection Diagnosis Clinical presentation: systemic condition local condition organic-systemic dysfunction specific expression Investigation: experiment test imaging: US, X-ray,CT, MRI Management Local treatment: protect infection site superficial lesion deep lesion Antibiotics: Management Improve systemic conditions: hydro-electrolyte, nutrition companion diseases Superficial soft tissue suppurative infection Furuncle Acute suppurative infection within one hairfollicle and surrounding tissue Pathology: acute suppurative inflammation congestion and exudation of components of blood Furunculosis: infection of several hair follicles in a circumscribed area. Furunculoisis Carbuncle A confluent infection involving multiple contiguous follicles in which the infection is limited to the subcutaneous tissue by thick overlying skin and dense subcutaneous fascia. Carbuncles require incision for drainage and treatment. Cellulites acute infection of loosing connective tissue. Pathogens: B-hemolytic Streptococci or Staphylococci aureus Clinical presentation: redness of skin, swilling and boundless Anaerobic cellulites: crepitation Treatment: antibiotics incision and draninage Erysipelas Skin wound lymphadenitis local inflammation systemic inflammation Redness of skin with clear boundary Edema of proximal lymphanode Systemic sepsis Abscess Characterized by a necrotic center without a blood supply and composed of debris from local tissues, dead and dying leukocytes, components of blood and plasma and bacteria This semiliquid central portion (Pus) is surrounded by a vascularized zone of inflammatory tissue. Treatment Incision and drainage Antibiotics Acute suppurative infection of the hand paronychia lateral nail fold trauma redness, pain suppurative infection Treatment: incision and drainage removal of the nail: infection extend deep to the nail antibiotics felon paronychia spread or penetration wound pain fever WBC Treatment: incision and drainage antibiotics Suppurative tenovaginitis, bursitis and infection of palm spaces infection of the flexor tendon sheath, bursts and palm spaces, which is usually caused by a puncture wound to the volar aspect of the digit or palm thenar space midpalmer space hypothenar space Treatment incision irrigation and drainage antibiotics