RECENT TRENDS IN MANAGEMENT OF SURGICAL SITE INFECTIONS
Nader Mohammed Attia;
Abstract
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). Surgical site infections are one of the important types of healthcare- associated infections (HCAIs); representing approximately 15% of all nosocomial infections in hospitalized patients. Among surgical patients, however, surgical site infections are the most common nosocomial infections accounting for about 37% of their hospital-acquired infections.
SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related at least in part, to SSI.
For surgical site infection to occur there must be microbial contamination of the surgical site. However, not all microbial contamination results in SSI; also, the same bacterial inoculum does not always result in SSI.
The more virulent the bacterial contamination, the greater the probability of infection.
The identification of SSI involves interpretation of clinical, laboratory and radiological findings, that a surveillance program use definitions that are consistent and standardized, otherwise, inaccurate SSI rates will be estimated and reported.
Nonspecific clinical signs mimicking infection frequently occur in postoperative period, making the diagnosis difficult. These signs include wound erythema and induration secondary to lymphatic and venous obstruction, fever, and leukocytosis. Most SSIs present from 3 to 14 days postoperatively.
Erythrocyte sedimentation rate (ESR) is a sensitive marker for infection but lacks specificity, C-reactive protein (CRP) is similarly raised in the large majority of cases.
Blood culture is a simple and cost-effective method for identifying bacterial agents, as the infection is mostly monomicrobial, but it must be done at time of fever.
Bacteria are responsible for the majority of SSIs. Specific species are classified using Gram's stain and growth characteristics on specific media.
Ultrasonography and computed tomography (CT) scan may be required if organ space collection is suspected or in monitoring treatment.
The prevention or minimization of risk, of SSI requires knowledge of all the risk factors for infection and the modification of each of these as much as possible. Although discussion of the prevention of SSI is often focused on antimicrobial prophylaxis timing and choices, other important factors must be considered.
Once SSIs occur, their treatment consists of two aspects; these are the drainage of infected tissues or fluids from the wound and the provision of appropriate antimicrobial therapy.
Vacuum-assisted closure is a relatively new technique in which controlled negative pressure is used to provide evacuation of wound oedema, to increase blood flow, to decrease bacterial load and to increase the formation of granulation tissue. It may reduce the need for multiple debridements, avoid the cost and morbidity of harvesting soft-tissue flaps and provide successful clinical outcomes.
Hyperbaric oxygen therapy is also a recent technique that could be used adjunctively with surgical debridement and aggressive antibiotic therapy, as it offers several mechanisms of action to control the infection and reduce tissue loss.
SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related at least in part, to SSI.
For surgical site infection to occur there must be microbial contamination of the surgical site. However, not all microbial contamination results in SSI; also, the same bacterial inoculum does not always result in SSI.
The more virulent the bacterial contamination, the greater the probability of infection.
The identification of SSI involves interpretation of clinical, laboratory and radiological findings, that a surveillance program use definitions that are consistent and standardized, otherwise, inaccurate SSI rates will be estimated and reported.
Nonspecific clinical signs mimicking infection frequently occur in postoperative period, making the diagnosis difficult. These signs include wound erythema and induration secondary to lymphatic and venous obstruction, fever, and leukocytosis. Most SSIs present from 3 to 14 days postoperatively.
Erythrocyte sedimentation rate (ESR) is a sensitive marker for infection but lacks specificity, C-reactive protein (CRP) is similarly raised in the large majority of cases.
Blood culture is a simple and cost-effective method for identifying bacterial agents, as the infection is mostly monomicrobial, but it must be done at time of fever.
Bacteria are responsible for the majority of SSIs. Specific species are classified using Gram's stain and growth characteristics on specific media.
Ultrasonography and computed tomography (CT) scan may be required if organ space collection is suspected or in monitoring treatment.
The prevention or minimization of risk, of SSI requires knowledge of all the risk factors for infection and the modification of each of these as much as possible. Although discussion of the prevention of SSI is often focused on antimicrobial prophylaxis timing and choices, other important factors must be considered.
Once SSIs occur, their treatment consists of two aspects; these are the drainage of infected tissues or fluids from the wound and the provision of appropriate antimicrobial therapy.
Vacuum-assisted closure is a relatively new technique in which controlled negative pressure is used to provide evacuation of wound oedema, to increase blood flow, to decrease bacterial load and to increase the formation of granulation tissue. It may reduce the need for multiple debridements, avoid the cost and morbidity of harvesting soft-tissue flaps and provide successful clinical outcomes.
Hyperbaric oxygen therapy is also a recent technique that could be used adjunctively with surgical debridement and aggressive antibiotic therapy, as it offers several mechanisms of action to control the infection and reduce tissue loss.
Other data
| Title | RECENT TRENDS IN MANAGEMENT OF SURGICAL SITE INFECTIONS | Other Titles | الطرق الحديثة في علاج التهابات المواقع الجراحية | Authors | Nader Mohammed Attia | Issue Date | 2014 |
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