CURRENT Essentials of Critical Care.pdf

Chapter 10 Infectious Disease 155■■■Surgical Site Infection (SSI)Essentials of Diagnosis• Infection of surgical incision site(s), both superficial and deep• Endogenous or hospital-acquired flora involved; usually occurswithin 4–8 days of surgery, if caused by staphylococci and gramnegativeorganisms; earlier infection (48 hours) caused byclostridia and beta-hemolytic streptococci• Risk factors include host (extremes of age, poor nutritional status,diabetes, smoking, obesity, coexisting remote infection, bacterialcolonization, altered immune response, prolonged preoperativehospital stay); operative factors (hygiene and antisepticprocedures, prophylactic antibiotics); postoperative factors (incisioncare)Differential Diagnosis• Other causes of postoperative fever (eg, atelectasis, thrombophlebitis,aspiration and drug reaction)• Inadequate postoperative pain controlTreatment• Exploration of surgical wound or site of suspected infection;fluid draining from wound should have Gram stain and culture• Debridement of necrotic tissue and/or removal of foreign body• Antibiotic therapy targeting nosocomial gram positive as wellas gram negative organisms■ PearlAntimicrobial prophylaxis indicated in surgery involving opening hollowviscus, placement of foreign bodies, or when potential SSI posescatastrophic risk; should consist of 1–2 doses of antibiotics only, administeredpre- and sometimes postoperatively, to decrease intraoperativeorganism burden.ReferenceMangram AJ: Guideline for prevention of surgical site infection 1999. HospitalInfection Control Practices Advisory Committee. Infect Control HospEpidemiol 1999;20:250. [PMID: 10219875]