5   Surgical infections and antibiotic

Done  By:   Reviewed  By:  

Tuqa  Alkaff   Mohammed  Jameel  

COLOR  GUIDE: •  Females'  Notes          •  Males'  Notes          •  Important            •  Additional  

  

Objectives
Not  given,,!    
   

1
Infection:  
Infection  is  defined  by:  
1.  Microorganisms  in  host  tissue  or  the  bloodstream    

2.  Inflammatory  response  to  their  presence.  

Inflammatory  Response:  
Localized:  Rubor,  Calor,  Dolor,  Tumor,  and  functio  laesa  (loss  of  function).  

Systemic:  Systemic  Inflammatory  Response  Syndrome  (SIRS)  

 
 

 
 

 
Note(s):  
S.I.R.S.  
1-­‐
Any  Two  of  the  Following  Criteria:   Trauma,Aspiration,Pancr
eatitis  and  burn  could  
1.  Temperature:  less  than  36°C  or  greater  than  38°C.   cause  inflammation  
without  infection  
Calor,  dolor,  rubor,  and  
2.  Heart  Rate:  greater  than  90  beats  per  minute   tumor:  Heat,  pain,  
redness,  and  swelling.  The  
3.   Respiratory   Rate:   greater   than   20   breaths   per   minute   four  classical  signs  of  
inflammation,  originally  
(Tachypnea)   recorded  by  the  Roman  
encyclopedist  Celsus  in  the  
4.   WBC:   less   than   4000   cells/mm³   or   greater   than   12,000   1st  century  A.D.  
cells/mm³    
2-­‐Systemic  inflammatory  
response:  affects  all  the  
*Sepsis:   SIRS   plus   evidence   of   local   or   systemic   infection.   body  systems  
*Septic   Shock:   Sepsis   plus   end   organ   hypoprofusion.   WBC<4000  in  
immunocompromised  
Mortality  of  up  to  40%   patients  

2
Introduction  
Ó Surgery,   trauma,   non-­‐trauma   local   invasion   can   lead   to   bacterial   insult.   Once  
present,  bacteria,  initiate  the  host  defense  processes.  Inflammatory  mediators  
(kinins,   histamine,   etc.)   are   released,   compliment   and   plasma   proteins   are  
released,  PMN’s  “polymorphonuclear  leukocytes”  arrive,  etc  
Ó Many  established  factors  have  a  role  in  infection.  These  can  be  either  surgical  
factors   or   patient-­‐specific   factors.   Patient-­‐specific   factors   can   be   further  
defined  as  either  local  or  systemic  

Surgical  Risk  Factors    

1) Type  of  procedure  “will  mention  it  later”  
Note(s):  
2) Degree  of  contamination    
3) Duration  of  operation   Urgency  of  operation*:  
urgent  surgeries  not  like  
4) Urgency  of  operation*   elective  ones  ,surgeons  
have  time  to  scrub  and  be  
SPREAD  OF  SURGICAL  INFECTIONS   prepared.  
 
Phlegmons**:early  phase  
1) NECROTIZING  INFECTION   of  abcess    
2) ABSCESSES  
3) PHLEGMONS**  AND  SURPERFICIAL  INFECTIONS    
4) SPREAD  OF  INFECTIONS  VIA  THE  LYMPHATIC  SYSTEM    
5) SPREAD  OF  INFECTION  VIA  BLOODSREAM  

COMPLICATIONS  OF  SURGICAL  INFECTION   Note(s):  

1) Fistulas***  and  sinus  tract     A  fistula***  is  an  

abnormal  connection  
2) Suppressed  wound  healing   between  anorgan,  vessel,  
or  intestine  and  another  
3) Immunosuppression  and  superinfection   structure.Fistulas  are  
usually  the  result  of  
4) Bacteremia     injury  or  surgery.  It  can  
5) Organ  dysfunction  Sepsis,  and  systemic   also  result  from  infection  
or  inflammation.    
inflammatory  response  syndrome  

3
CLINICAL  FINDIINGS  AND  DIAGNOSIS  
1. Physical  examination:  Warmth,  erythema,  induration,  tenderness    
2. Laboratory  findings  General  findings:  Leukocytosis,  
acidosis,  and  signs  of  disseminated  intravascular   Note(s):  
coagulation   -­‐  In  appendicitis  :Normal  
3. Cultures   lucocytes,  high  neutrophils.  
4. Imaging  studies   -­‐Blood  Cultures  are  done  if  the  
5. Source  of  infection   patient  is  febrile  and  sick  but  
not  after  antibiotics,  it  will  be  
TREATMENT   useless  

-­‐Necrotizing  fascitits  appears  

Ø Incision  and  drainage  “mostly  with  skin  or  mass  
bubbly  on  CT  scan.  
lesions,  e.g.:  abscess”  
 -­‐  Examination:  inspection  eg:  
Ø Excision  “e.g.:  sebaceous  cyst,  foreign  
wasting  of  temporalis  muscle.”  
body,diabetic  foot”   (Temporalis  Muscle  
Ø Antibiotics   Wasting:  Loss  of  temporalis  
Ø Nutritional  support.   muscle  mass  commonly  seen  
  in  cases  of  significant  
 
catabolism  and/or  generalized  
  nutritional  deficiency)

Infection Types:      

-­‐  Blood  tests  e.g.:  -­‐  albumin  to  

Two  main  types:     know  the  chronic  status  of  the  
patient.  
i. Community-­‐Acquired    
-­‐  Pre-­‐albumin  to  know  the  
ii. Hospital-­‐Acquired   current  status  of  the  patient  
   -­‐When  can  we  say  this  weight  
loss  is  significant?  If  it  is  More  
Community-­‐Acquired:   than  10  kg  over  the  past  6  
months.    
Ø Skin/soft  tissue  Cellulitis:    
Ø Group  A  strep  
Ø Carbuncles/furuncle:  Staph  aureus    
Ø Necrotizing:  Mixed    
Ø Hiradenitis  suppurativa:  Staph  aureus  
Ø  Lymphangitis:  Staph  aureus.  

4
Cellulitis  
Ø Definition:  Diffuse  infection  with  severe  inflammation  of  dermal  and  
subcutaneous  layers  of  the  skin.    
Ø Diagnosis:  Pain,  Warmth,  Hyperesthesia  
Ø Treatment:  Antibiotics.”  
Ø Common  Pathogens:  Skin  Flora  (Streptococcus/Staphylococcus)  

   

  Cellulitis   Treatment:Antibiotics.“With  observation  

by   drawing   borders   around   the   affected   area   to  
 Cellulitis:  observe  the  swollen  leg.     check   if   there   is   a   response   to   the   treatment   or  
not  
 
  Note(s):  
FURUNCLES  AND  CARBUNCLES   -­‐Furuncles*:infect  one  
hair  follicle.  
v Furuncles*  and  carbuncles**  are  cutaneous  abscess  that    
-­‐Carbuncles**:Fistulous  
begin  in  skin  glands  and  hair  follicles.   and  sinuses  between  a  
v If  the  pilosebaceous  apparatus***  becomes  obstructed   group  of  hair  follicles  
 
at  the  skin  level,  the  development  of  a  furuncle  can  be  
-­‐The  sebaceous  
anticipate.   glands  open  into  
v A  carbuncle  is  a  deep  –seated  mass  of  fistulous  tracts   the  hair  follicles,  and  
together  these  form  
between  infected  hair  follicles.     the  pilosebaceous  
apparatus***  
Furuncles  are  the  most  common  surgical  infections,  but  
carbuncles  are  rare.  

5
  

 
 
  A  furuncle  is  an  acute,  round,  firm,  tender,  
circumscribed,  perifollicular  staphylococcal  
pyoderma  that  usually  ends  in  central   carbuncle   is   two   or   more   confluent  
suppuration.     furuncles  with  separate  heads .  

HIDRADENITIS  
Serious  skin  infection  of  the  axillae  or  groin  Consisting  of  multiple  abscesses  of  the  
apocrine  sweat  glands.  The  condition  often  becomes  chronic.  The  cause  is  unknown  
but  may  involve  a  defect  of  terminal  follicular.  

 
 
 
 
HIDRADENITIS  

 
TREATMENT:  
v The  classic  therapy  of  furuncle  is  drainage,  not  antibiotics.  
v Invasive  carbuncles  must  be  treated  by  excision  and  antibiotics.  
v Hidradenitis  is  usually  treated  by  drainage  of  the  individual  abscess  and  
followed  by  careful  hygiene.  Usually  not  improved  by  antibiotics,  it  needs  
excision.    

Lymphangitis  (blister)  
Lymphangitis  arising  from  cellulitis  produces  red,  warm,  tender  streaks  3-­‐4  mm  wide,  
spreads  from  the  infection  along  lymphatic  vessels  to  the  regional  lymph  nodes.    

6
Breast  Abscess    
Ø Staphylococcal  infection    
Ø Usually  post-­‐partum    
Induration   and   redness   over   the   inner  
Ø MRSA  (Methicillin-­‐resistant  Staphylococcus   area  of  the  right  sided  breast  ready  to  
rupture.  
aureus  )  is  uncommon.  

Abscess  
Note(s):  
Definition:  Infectious  accumulation  of  purulent  material  
-­‐Lymphangitis:infection  
(Neutrophils)  in  a  closed  cavity   spreads  by  lymphatic  
channels,in  examination  you  
Diagnosis:  Fluctuation  test:  Moveable  and  compressible   feel  it  as  a  cord  like  
 
-­‐Breast  Abscess  usually  post-­‐
Treatment:  Drainage   partum  in  lactation.  
Rx:  Treatment:  mature  

  Abscess:  Incision  and  

drainage.  Some  surgeons  try  
antibiotic  if  the  abscess    
is  not  mature  enough  or  if  
  there  is  no  fluctuation  w hen  
they  do  the  examination..  
 
  -­‐If  there  is  evidence  of  
cellulitis(skin  changes),give  
antibiotics,but  if  the  patient  
  Diffuse+subcutaneous   abscess,   different   didn’t  respond  think  of  MRSA  
than  furuncle(not  area  of  hair  follicle)    
follicle  
 
Peri-­‐rectal  abscess    
Results  from  infection  of  the  anal  crypts.  Can  be  extensive  .Can  result  in  bacteremia  
Treatment:  Incision  and  drainage.  

Diabetic  Foot  Infection  

Diabetic   foot   infection   secondary   to   depressed  

immunity,  ends  up  by  amputation.  

7
Hand Infections:
1-­‐Paronychia  
An  inflammatory  reaction  involving  the  folds  of  the  skin  
surrounding  the  fingernail.  It  is  characterized  by  acute  or  
chronic  purulent,  tender,  and  painful  swellings  of  the  
tissues  around  the  nail,  caused  by  an  abscess  of  the  nail  
fold.  The  pathogenic  yeast  causing  paronychia  is  most  
frequently  Candida  albicans.  The  causative  bacteria  are  
usually  Staphylococcus,  Pseudomonas  aeruginosa,  or   Paronychia:   infection   of   the  skin   fold  

Streptococcus.   around  the  nails  

Treatment:  Incision  and  drainage,  if  not  responding  antibiotic.  

2-­‐Felon  
v Closed-­‐space  infections  of  the  fingertip  pulp.  
v Treatment  :Incision    
v Paronychia  can  lead  to  felon  
 

Both  can  lead  to  tenosynovitis*  

Felon.  
 
 

 
 
*  Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a
tendon. Symptoms of tenosynovitis include pain, swelling and difficulty moving the particular joint
where the inflammation occurs. When the condition causes the finger to "stick" in a flexed
position, this is called "stenosing" tenosynovitis, commonly known as "trigger finger".

8
DIFFUSE  NECROTIZING  INFECTIONS   Note(s):  
Particular  dangerous,  difficult  to  diagnose,  extremely   DIFFUSE  NECROTIZING  
INFECTIONS  limited  to  
toxic,  spread  rapidly,  often  leading  to  limb  amputation.   upper  and  lower  limbs  
most  of  the  time.  
Pathogenic  factors:  
1. Anaerobic    
2. Wound  Bacterial  exotoxins  
3. Bacterial  synergy  “multiple”      
4. Thrombosis  of  nutrient  bridging  vessels  is  a  result  of  necrotizing  infection.  

Classification:  
1-­‐Clostridial  “mostly  skin  and  soft  tissue”  
Ø Necrotizing  cellulitis  
Ø Myositis    

2-­‐Nonclostridial  “mostly  deep  to  the  fascia”   Note(s):  

Treatment  of  clostridial  
Ø Necrotizing  fasciitis  (deep  infection)     infections:  broad  spectrum  
Ø Streptococcal  gangrene  (most  common)   antibiotics  till  you  see  the  
response.  
 
Crepitant  abscess  in  
Clostridial  Infections:     clostridial  infections  is  <40%  
or  less  (rare)  
1) They  are  fastidious  anaerobes.  
2) A  broad  spectrum  of  disease  is  caused  by  clostridia.  
3) On  gram-­‐stain  they  appear  as  relatively  large,  gram-­‐positive,  rod-­‐shaped  
bacteria.    

Clinical  Findings:  Crepitant  abscess  or  cellulitis  Invasion  is  usually  superficial  to  the  
deep  fascia  and  may  spread  very  quickly,  producing  discoloration.  Delayed  
debridement  of  injured  tissue  after  devascularizing  injury  is  the  common  setting.  

9
 Note(s):  
Gas  Gangrene   Patient  presented  with  severe  
pain>>  think  about  myositis.  
Ú Clinical  Findings:  Severe  pain  suggests  extension   Gas  Gangrene  spreads  by  
into  muscle  compartments  (myositis).     blood,there  is  a  quick  loss  of  
Ú The  disease  progresses  rapidly,  with  loss  of  blood   blood  that  if  it’s  not  treated  
the  patient  dies  or  end  by  
supply  to  the  infected  tissue.     septic  shock    
Ú Profound  shock  can  appear  early,  rapidly  
leading  to  organ  dysfunction.    
Ú  Air  bubbles  often  visible  on  plain  radiograph  
Crepitus  may  be  present,  but  not  reliable  to  
differentiation.    
 
 

Nonclostridial  Infections   Gas  Gangrene:  Skin  changes  +  Blisters  

Ú Caused  by  multiple  nonclostridial  bacterial  pathogens.Microaerophilic  

streptococci,  staphylococci,  aerobic  gram-­‐negative  bacteria,  and  anaerobes,  
especially  peptostreptococci  and  bacteroides.  
 
Ú Clinical  Findings:  Usually  begins  in  a  localized  area  such  as  a  puncture  wound,  
leg  ulcer,  or  surgical  wound.  Externally,  hemorrhagic  bullae  are  usually  the  first  
sign  of  skin  death  .The  skin  is  anesthetic  and  crepitus  is  occasionally  present.  
The  fascial  necrosis  is  usually  wider  than  the  skin  appearance  indicates.    
Ú At  operation,  the  finding  of  edematous,  dull-­‐gray,  and  necrotic  fascia  and  
subcutaneous  tissue  confirm  the  diagnosis.  

 
Note(s):  Crepitant  abscess  in  
Nonclostridial  infections  is  
>40%.  
 

Treatment  in  clostridial  and    

Nonclostridial  infections  is  
debridement,  and  oxygenation    
to  enhance  blood  supply.  
  Necrotizing  soft  tissue  infection  

10
Streptococcal  gangrene  Group  A   Note(s):  
Usually  wound  infections  
Ó Streptococcus  is  a  bacterium  frequently  found  in  in  the   appear  7  days  after  the  
skin  and  throat.     surgery  except  
Ó Streptococcal  gangrene  is  uncommon   Streptococcal  gangrene  
Group  A(non  clostridial)  
Ó The  sudden  onset  of  severe  pain  is  the  most  common    
and  clostridial  infections  
Ó presenting  symptom,  usually  in  an  extremity  associated   which  appear  1  day  after  
with  a  wound.  
 
Ó Fever  and  other  signs  of  systemic  infection  are  
frequently  present  at  the  time  of  presentation.  
Ó Shock  and  renal  dysfunction  are  usually  present  within  24  hours.    

TREATMENT:  

1. Complete  debridement  and  depress  tight  fascial  compartment.  Amputation.  

2. Broad-­‐spectrum  antibiotic  therapy    
3. Resuscitative  therapy    
4. Treat  diabetes  mellitus  aggressively    
5. Hyperbaric  oxygenation  inhibit  bacterial  invasion  but  does  not  eliminate  the  
focus  of  infection.  

Biliary  Tract:  
Usually  result  from  obstruction    

Usual  suspects:  E.  coli,  Klebsiella,  Enterococci    

Acute  Cholecystitis:  
GB  empyema    

Ascending  cholangitis    
Diagnosis:  ultrasound  .Treatment:  antibiotics,  relive  the  obstruction.  

11
Peritonitis    
Causes:  appendicitis,  Acute  Cholecystitis,  …etc  

Diagnosis:  history  and  examination  

Treatment:  treat  the  underlying  cause  

Viral:  Hepatitis,  HIV/AIDS  

Tetanus:   Note(s):  
Always  check  tetanus  
C.  tetani  infection  “  Lock-­‐jaw”     vaccine  if  trauma  happens  

Caused  by  exotoxin,  Treatment:  immunization.  

Post-­‐Operative  Infections:  
v Fever  After  Surgery  

The  “Five  W’s”  “possible  causes  for  postoperative  fever”:    

Note(s):  
1) Wind:  Atelectasis    
2) Water:  UTI  (Urinary  Track  Infection)   Wind:  Atelectasis=collapse  of  
3) Walking:  DVT  (Deep  Vein  Thrombosis)   the  lungs.  
4) Wonder  Drug:  Medication  Induced      
5) Wound:  Surgical  Site  Infection   Infections  after  surgery:  
 
Other  causes  of  post-­‐operative  fever  include:   1st  day:drug  reaction  or  
6) Blood  transfusion  ·∙   already  has  infection  not  
7) Preoperative  misdiagnosis  “pneumonia”     discovered  by  surgeons.  
 
8) Malignant  hyperthermia*  “one  of  the  important  and   2nd  day:  pneumonia,  
most  common  causes,  very  important  to  ask  about  it  in   thrombophlebitis.  
 
the  family  history”   3rd_5 th  day:Urinary  tract  
infections.  
 
  5th_7 th  day:pulmonary  
embolism+vein  thrombosis  
   
7th-­‐10th  day:wound  infection  
except  group  A  strepcocus    
 

*Malignant hyperthermia is disease passed down through families that causes a fast rise in body temperature
(fever) and severe muscle contractions when the affected person gets general anesthesia

12
Surgical Site Infections “SSI” Note(s):  

3rd  most  common  hospital  infection:   Examine  signs  of  infection:  

could  be  superficial  or  d eep  
v Incisional     which  reaches  the  organ.  

Ø Superficial  
Ø Deep  
v Organ  Space:  
Ø Generalized  (peritonitis)    
Ø Abscess  
 

SSI-­‐Infection:  
Ó Definition:  Surgical  sites  are  considered  infected  when  there  are  Systemic  and  
local  signs  of  inflammation.  
Ó Bacterial  counts  ≥  105  cfu/mL.  Purulent  versus  non-­‐purulent    
Ó The  length  of  stay  for  the  patient  and  economic  effects  of  the  hospital  stay  are  
important  factors  to  consider  in  SSIs.    
Ó Note  that  Surgical  wound  infection  is  SSI    
 
 
1-­‐  Superficial  Incisional  SSI:    
Infection  occurs  within  30  days  after  the  operation  and  involves  only  skin  or  
subcutaneous  tissue  of  the  incision    
 
    Skin
 
 
 
 
 
    Subcutanous Tissue

 
 

13
2-­‐  Deep  Incisional  SSI:  
 
A  more  serious  SSI.  Extends  past  the  superficial  layer.  The  
infection  occurs  within  30  days  post-­‐operation  only  if  no  implant  
is  left  in  place  or  within  1  year  if  implant(ex:silicone)  is  in  place  
and  the  infection  appears  to  be  related  to  the  operation  and  the  
infection  involves  the  deep  soft  tissue,  which  include  the  fascia  
and  muscle  layers.    
 
3-­‐  Organ/Space  SSI  
 
The  most  extensive  of  these  surgical  infections  involves  the  organs  and  the  space  surrounding  the  
organs.  These  infections  can  occur  within  30  days  post-­‐op  if  no  implant  is  left  in  place  or  within  1  
year  if  an  implant  is  in  place  and  the  infection  appears  to  be  related  to  the  operation  and  the  
infection  involves  any  part  of  the  anatomy,  other  than  the  incision,  which  was  opened  or  
manipulated  during  the  operation  
 
SSI  –  Risk  Factors:  
 
Operation  Factors   Patient  Characteristics  
 
 
1. Duration  of  surgical  scrub.   1. Advanced  age  
  2. Maintenance  of  body  temperature.     2. Diabetes:  HbA1C  and  SSI  
  3. The  use  of  skin  antisepsis.   Glucose  >  200  mg/dL  postoperative  
4. Preoperative  shaving.   period  (<48  hours)  
  5. Duration  of  operation.   3. Nicotine  use:  delays  primary  wound  
  6. Antimicrobial  prophylaxis.   healing  
7. Operating  room  ventilation.   4. Steroid  use:  controversial  
  8. inadequate  sterilization  of   5. Malnutrition:  no  epidemiological  
  instruments.   association  
  6. Obesity:  20%  over  ideal  body  weight  
  9. Foreign  material  at  surgical  site.   7. Prolonged  preoperative  stay:  
    surrogate  of  the  severity  of  illness  
10. Surgical  drains.   and  comorbid  conditions  
    8. Preoperative  nares  colonization  with  
  11. Surgical  technique,  Poor  surgical   Staphylococcus  aureus:    
technique  includes:   9. significant  association  
    10. Perioperative  transfusion:  
  v Poor  hemostasis.   controversial  
v Failure  to  obliterate  dead  space.     11. Coexistent  infections  at  a  remote  
  v Tissue  trauma.   body  site  
  12. Altered  immune  response  

14
 Note(s):  
Perioperative  Glucose  Control:     Albumin<5  is  a  source  of  
Patients  with  a  blood  sugar  >  300  mg/dL  during  or  within   infection  

48  hours  of  surgery  had  more  than  3times  the  likelihood  of   Preoperative  preparations    
a  wound  infection.  
• Patient  should  stop  
  smoking  6  weeks  
    prior  to  the  surgery  
Pre-­‐operative  Shaving     • Measure  the  patient’s  
temperature  
Shaving  the  surgical  site  with  a  razor  induces  small  skin  
• Take  shower  1  day  
lacerations     before  the  surgery  
Potential  sites  for  infection     • Weight  reduction  is  
Ó Disturbs  hair  follicles  which  are  often  colonized  with   advised  
S.aureus.    
Ó Risk  greatest  when  done  the  night  before.  
Ó Patient  education  :Be  sure  patients  know  that  they  should  not  do  you  a  favor  
and  shave  before  they  come  to  the  hospital!  
 
 
Prophylactic  Antibiotics:  
Ó Antibiotics  given  “IV”  for  the  purpose  of  preventing  infection  when  infection  is  
not  present  but  the  risk  of  postoperative  infection  is  present.  
Ó Decreases  bacterial  counts  at  surgical  site  
Ó Given  within  30  minutes  prior  to  starting  surgery  
Ó Vancomycin  1-­‐2  hours  prior  to  surgery  
Ó Redose  for  longer  surgery  
Ó Do  not  continue  beyond  24  hours  
 
Surgical  site  prevention:  
• Use  antibiotics  appropriately    
• Maintain  normal  Body  temp  
• Maintain  normal  Blood  glucose  
• Optimize  oxygen  tension    
• Avoid  shaving  Site    
 
Treatment  
Incisional:  open  surgical  wound,  antibiotics  for  cellulitis  or  sepsis  
Deep/Organ  space:  Source  control,  antibiotics  for  sepsis  
 
 

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Types  of  surgery  
 
 
 
Clean     Hernia  repair   1.5%    
breast  biopsy  
Note(s):    
Clean-­‐ Cholecystectomy   2-­‐5%  
Hernia  is  a  clean  surgery.  
 
Contaminated    planned  bowel  
resection   Antibiotics  aren’t  needed    
Contaminated     Non-­‐preped  bowel   5-­‐ unless  there  is  foreign    
resection   30%   body    
Dirty/infected     perforation,  abscess   5-­‐  
30%    
 
 
 
 
Not  important*  
Occupational  Blood  Bourne  Virus  Infections  
 
  HBV   HCV   HIV  
 
  Risk  from     30%   2%   0.3%  

Needle  stick  
 
Chemoprophylaxis   Yes   No   Yes  
 
Vaccine   Yes   No   No  
 

 
 

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   SUMMARY  
  1. Inflammatory  response:  localized  or  systemic.    
2. SIRS  :  any  2  of  the  following  :    
  -­‐ Temperature.  
-­‐ Heart  rate.    
 
-­‐ Respiratory  rate    
  -­‐ WBC    
3. Spread  of  surgical  infection  through  :  
 
-­‐ Lymphatic  system    
  -­‐ Blood  stream    
4. Treatment  :    
  -­‐ Excision,  Incision  and  drainage  ,  Antibiotics  and  Nutritional  support    

                 5.      infection  types  :    

  -­‐  community  aquired  and  hospital  aquired    

                 6.  community  aquired  infections:    

  Cellulitis:  skin  flora  -­‐  antibiotic  

carbuncles\furuncle:    
 
carbuncle  is  a  deep  –seated  mass  of  fistulous  tracts  between  infected  hair  follicles  -­‐  
  treated  by  excision  and  antibiotics.  
furuncle  the  most  common  surgical  infections  –  treatment  is  drainage    
  necrotizing,  
 hiradenitis  suppurative:  treated  by  drainage  of  the  individual  abscess  and  followed  by  
 
careful  hygeine.  
 a   nd  lymphagenits        

                 7.    hand  infections:  Paronychia  

  and  Felon  

                           Both  can  lead  to  tenosynovitis.    

             8.    post  operative  infections    

Ú fever  and  five  Ws  

Ú Wind:  Atelectisis  
Ú Water:  UTI  
Ú Walking:  DVT  
Ú Wonder  Drug:  Medication  Induced    
Ú Wound:  Surgical  Site  Infection  

   

 
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 IMPORTANT  NOTES  FROM  EXTERNAL  RESOURCES  
  Notes  
Essential  surgery   All  the  tables  from  it  =)  
Problems,  diagnosis  and   Except  the  last  one,  it  is  from  Raslan’s  textbook  
management  
”recommended  book”  
   
   

Questions
1) A  40  yo  female  underwent  left  breast  mastectomy  
presented  with  left  arm  edema  ?  
a. Obstruction of lymphatic drainage
b. Blood vessel damage
c. Skin infection
d. Complication of drugs
 
2) Patient  has  wound  and  came  to  the  ER  the  registrar  said  
for  the  intern  suture  it,  the  intern  should  check  for  
which  of  the  following  vaccinations      ?  
a. Tetanus
b. Hepatitis
c. Influenza

3) What  is  the  most  surgical  infection?  

A – lymphadenitis
B – cellulitis
C – furuncle
D – necrotizing

  Answers:    
432  Surgery  Team  Leaders  
1st  Question:  A  
                     Manar  Al  Eid                    &                    Omar  Al  Zuman    
Surgeryteam432@gmail.com   2nd  Question:  A  

3rd  Question:  C  

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