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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.

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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.

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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.

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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.

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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 of therapy.

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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.

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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.

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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 ...

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