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Surgical site infections

Background knowledge ๐Ÿง 

Definition

  • Infections occurring at or near a surgical incision within 30 days of the procedure or within 1 year if an implant is placed.
  • Includes superficial, deep, and organ/space infections.
  • Commonly caused by bacterial contamination.

Epidemiology

  • Occurs in 2-5% of patients undergoing surgery.
  • Higher rates in emergency, colorectal, and contaminated surgeries.
  • Significant morbidity and healthcare costs.
  • Risk factors: diabetes, obesity, immunosuppression, smoking.

Aetiology and Pathophysiology

  • Microbial contamination during surgery (Staphylococcus aureus, Streptococcus spp., etc.).
  • Patient-related factors (comorbidities, nutritional status).
  • Surgical technique and environmental factors.
  • Disruption of normal skin flora and immune response.

Types

  • Superficial incisional SSI: Skin and subcutaneous tissue involvement.
  • Deep incisional SSI: Deep soft tissues such as fascia and muscle.
  • Organ/space SSI: Any part of the body opened or manipulated during surgery.

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Pain and tenderness at the surgical site
  • Swelling and redness
  • Fever and malaise
  • Discharge from the wound

Signs

  • Erythema and warmth around the incision
  • Purulent drainage
  • Wound dehiscence
  • Localised pain on palpation

Investigations ๐Ÿงช

Tests

  • Wound swabs for culture and sensitivity.
  • Blood tests: FBC, CRP, ESR.
  • Imaging: Ultrasound, CT scan if abscess or deep infection suspected.
  • Microbiological analysis of any drainage.

Management ๐Ÿฅผ

Management

  • Antibiotic therapy based on culture results.
  • Surgical debridement if necessary.
  • Wound care: Regular dressing changes, maintaining a clean environment.
  • Pain management: Analgesics as required.
  • Monitoring for signs of systemic infection.

Complications

  • Sepsis and septic shock
  • Chronic wound infection
  • Wound dehiscence
  • Abscess formation
  • Scarring and cosmetic issues

Prognosis

  • Depends on timely diagnosis and treatment.
  • Most patients recover with appropriate management.
  • Complications can significantly impact recovery time.
  • Prevention strategies crucial to reduce incidence.

Key Points

  • Early recognition and intervention are vital.
  • Multidisciplinary approach improves outcomes.
  • Adherence to sterile techniques and prophylactic antibiotics.
  • Patient education on wound care and signs of infection.

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