Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 infection1. Clean: No gross contamination from exogenous or endogenous sources2. Clean-contaminated: For example, with gastric or biliary surgery3. Heavily contaminated: Operations on the unprepared colon or emergency operations for intestinal bleeding or perforation4. 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 +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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 +++ Laboratory Findings + • Leukocytosis• Increased ESR and C-reactive protein (CRP)• Bacteremia in complex deep wound infections• Wound culture may reveal source of infection +++ Imaging Findings + • Imaging may reveal abscess, soft-tissue swelling/edema, subcutaneous air (US or CT) + • 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 +++ Rule Out + • Necrotizing wound infection (high fever early postoperative, crepitus) + • 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 +++ When to Admit + • High fever, sepsis, dehydration• Failure to respond to opening of wound and/or oral antibiotics• Need for operative drainage + • Mild superficial wound infections may be treated successfully ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth