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  • • Postoperative wound infections resulting from bacterial contamination during or after a surgical procedure

    • Infection usually is confined to the subcutaneous tissues

    • Site infections are more likely if:

    • -Excessive tissue trauma

      -Undrained hamartomas

      -Retained foreign bodies

      -Excessively tight ligatures

      -Allowing wound to become desiccated

      -Contaminated

      -Poor perfusion

      -Poor oxygenation

      -Dead space

    • Degree of intraoperative contamination can be divided into 4 categories which correlate with risk of postoperative wound infection

    • 1. Clean: No gross contamination from exogenous or endogenous sources

      2. Clean-contaminated: For example, with gastric or biliary surgery

      3. Heavily contaminated: Operations on the unprepared colon or emergency operations for intestinal bleeding or perforation

      4. Infected

    • Classification of surgical site infection:

    • -Incisional: Superficial (skin and subcutaneous tissues) and deep incisional (deep soft tissue of the incision)

      -Organ/space infection: Any part of the anatomy other than body wall

    • Wound infections usually appear between the fifth and tenth postoperative days, but they may appear as early as the first postoperative day

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Epidemiology

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  • • Surgical site infections are the third most frequently reported nosocomial infection, accounting for 14-16% of all nosocomial infections in acutely hospitalized patients

    • Among surgical patients, surgical site infections are the most frequent nosocomial infections, accounting for 38% of the total

    • Infection rate per degree of contamination:

    • -Clean: 1.5%

      -Clean-contaminated: 2-5%

      -Heavily contaminated: 5-30%

      -Infected: 100%

    • Patient risk factors include:

    • -Diabetes mellitus

      -Nicotine use

      -Corticosteroids

      -Malnutrition

      -Poor hygiene

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Symptoms and Signs

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  • • Fever

    • Erythema

    • Pain

    • Swelling, induration

    • Palpation of the wound may disclose an abscess

    • Palpation may reveal areas of firmness, fluctuance, crepitus, or tenderness

    • Drainage from the wound may be free flowing or expressible

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Laboratory Findings

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  • • Leukocytosis

    • Increased ESR and C-reactive protein (CRP)

    • Bacteremia in complex deep wound infections

    • Wound culture may reveal source of infection

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Imaging Findings

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  • • Imaging may reveal abscess, soft-tissue swelling/edema, subcutaneous air (US or CT)

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  • • Differential diagnosis includes all other causes of postoperative fever

    • -Atelectasis

      -Urinary tract infection

      -Deep venous thrombosis

      -Medications

    • Wound dehiscence

    • Wound herniation

    • Necrotizing infection

    • Drug reaction

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Rule Out

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  • • Necrotizing wound infection (high fever early postoperative, crepitus)

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  • • Postoperative fever requires inspection of the wound

    • Palpation of the wound may disclose an abscess

    • Palpation may reveal areas of firmness, fluctuance, crepitus, or tenderness

    • Culture should be performed to help locate the source

    • Culture blood, urine, sputum to evaluate for other sources of fever and infection

    • Ensure adequate oxygenation/perfusion status

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When to Admit

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  • • High fever, sepsis, dehydration

    • Failure to respond to opening of wound and/or oral antibiotics

    • Need for operative drainage

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  • • Mild superficial wound infections may be treated successfully with IV antibiotics

    • Deep wound ...

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