1. The incidence of surgical site infections can be reduced
by appropriate patient preparation, timely perioperative antibiotic
administration, maintenance of perioperative normothermia and normoglycemia,
and appropriate wound management.
2. Principles relevant to appropriate antibiotic prophylaxis for
surgery: (a) select an agent with activity against common organisms
at the site of surgery, (b) the initial dose of the antibiotic should
be given within 30 minutes of incision, (c) antibiotics should be
redosed every 1 to 2 half-lives during surgery to ensure adequate
tissue levels, and (d) antibiotics should not be continued for more
than 24 hours after surgery for routine prophylaxis.
3. Source control is a key concept in the treatment of most surgically
relevant infections. Infected or necrotic material must be drained
or removed as part of the treatment plan in this setting. Delays
in adequate source control are associated with worsened outcomes.
4. Sepsis is both the presence of infection and the host response
to infection (systemic inflammatory response syndrome, SIRS). Sepsis
is a clinical spectrum, ranging from sepsis (SIRS plus infection)
to severe sepsis (organ dysfunction), to septic shock (hypotension
requiring vasopressors). Outcomes in patients with sepsis are improved
with an organized approach to therapy that includes rapid resuscitation,
antibiotics, and source control.
5. When using antimicrobial agents for therapy of serious infection,
several principles should be followed: (a) identify likely sources
of infection, (b) choose an agent (or agents) that covers likely
organisms for these sources, (c) remember that inadequate or delayed
antibiotic therapy results in increased mortality, so it is important
to begin therapy with broader coverage, (d) when possible, obtain
cultures early and use results to tailor therapy, (e) if there is
no infection identified after 3 days, strongly consider discontinuation
of antibiotics, and (f) stop antibiotics after an appropriate course
6. The keys to good outcomes in patients with necrotizing soft tissue
infection are early recognition and appropriate débridement
of infected tissue with repeated débridement until no further
signs of infection are present.
7. Transmission of HIV and other infections spread by blood and
body fluid from patient to health care worker can be minimized by
observation of universal precautions, which include routine use
of barriers when anticipating contact with blood or body fluids,
washing of hands and other skin surfaces immediately after contact
with blood or body fluids, and careful handling and disposal of
sharp instruments during and after use.
Although treatment of infection has been an integral part of
the surgeon’s practice since the dawn of time, the body
of knowledge that led to the present field of surgical infectious
disease was derived from the evolution of germ theory and antisepsis.
Application of the latter to clinical practice, concurrent with
the development of anesthesia, was pivotal in allowing surgeons
to expand their repertoire to encompass complex procedures that
previously were associated with extremely high rates of ...