Dr.

Saad Abdulkadir Muhammad

Board in general surgery
 INFECTION:
Infection :is the entry and multiplication of an infectious agent on the tissue ol
-Most staphylococci are now resistant to penicillin, whereas streptococci remain sensitive.
In addition , there is increasing concern about many other bacteria to antibiotics , in particular the
emergence of methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-resistant
enterococci (GRE), both are relevant in general surgical practice.
be divided into:
-Physiologically natural protective mechanism against infection
1- Chemical: low gastric PH.
2- Hormonal: antibodies , complements...
3- Cellular: phagocytic cells, macrophages, PMNs, killer lymphocyte.
 Period of Period of
Iness decline
Stages of infection
1- Incubation
2- Prodromal
3- Illness
4- Decline
5- Convalescence

Time
Classification of sources of infection:
1-Primary: acquired from a community or endogenous source such as(following perforated
peptic ulcer).
2-Secondary or exogenous: acquired from the operating theatre such as( inadequate air
filtration)or word(eg: poor hand washing compliance) or after surgery(anastomotic leak).

*Advances in control of infection in surgery:

1- Aseptic operating theatre techniques have replaced toxic antiseptic techniques.
2- Antibiotics have reduced post operative infection rates after surgery.
3- Delayed primary or secondary closure remains useful in contaminated wounds.
Resistance to infection:
-Resistance defined as the ability to limit pathogen burden.
*

1- Metabolic: malnutrition(obesity), diabetes, uremia , jaundice

2- Disseminated disease: cancer and acquired immunodeficiency syndrome (AIDS).
3- Iatrogenic: radiotherapy, chemotherapy, steroids.
Wound infection:
-Is defined as the presence of replicating microorganism within a wound leading to host/tissi
injury.
Risk factors for increased risk of wound infection:

1- Malnutition: obesity , weight loss.

2- Metabolic disease: diabetes, uremia , jaundice.
3- Immunosuppression: cancer, AIDS, steroids, chemotherapy and radiothera
4- Colonisation and translocation in gastrointestinal tract.
5- Poor perfusion: systemic shock or local ischemia.
6- Foreign body material.
7- poor surgical technique: dead space , haematoma.
Factors that determine whether a wound will become infected:
1- Host response
2- Virulence and inoculum of infective agent
3- Vascularity and health of tissue being invaded(including local ischemia as well as systemic
shock
4- presence of dead or foreign tissue
5- Precence of antibiotics during the “decisive period".
*surgical site infection (SSI):
-Is an infection that occurs after surgery in the part of the body where the surgery took place. -
SSI may be major or minor wound infection.
-The patient may have systemic signs such as tachycardia , pyrexia and raised WBC(systemic
inflammatory response syndrome)SIRS.
Is presence of bacteria in the blood stream.
is defined as the systemic manifestation of SIRS with documented infection.
sepsis with organ dysfunction.
ABSCESS:
-Is a collection of pus that has build up within the tissue of the body. It has all clinical feature of
acute inflammation. pus is collection of dead/dying leukocyte and bacteria. Pyogenic organism
predominantly staphylococcus aureus, that cause tissue necrosis and suppuration.
-Abscess contain hyperosmolar material that draw in fluid . This increases the pressure and causes
pain.
-Types of abscess:

-Depending on duration; acute or chronic -

Depending on nature; pyogenic , pyemic , cold.
Investigation:
-Haematological; CBC , ESR
-Biochemical; BUN , Serum creatinine,LFT , Blood suger -
Pathological; swab
-Radiological; x-ray, ultra sound , CT scan , MRI
*Treatment:
-Rest, antibiotic , surgery(drainage).

Complication:
-Spread
-Inadequate drainage......sinus/fistula
-Formation of antibioma eg. Breast abscess -formation
of chronic abscess.
Cellulitis:
-Is the non suppurative invasive infection of tissues. There is poor localisation in addition to the
cardinal signs of inflammation . Spreading infection presenting in surgical practice is typically
caused by organisms such as B-hemolytic streptococci , staphylococci , C. perfringens. Tissue
destruction , gangrene and ulceration may follow , which are caused by release of proteases.
-Systemic signs are common: SIRS , chills , fever and rigors. These follow the release of organism,
exotoxins and cytokines into the circulation. Blood culture often negative.

-Diagnosis; swab any wound discharge

for culture and sensitivity test.
-Also based on clinical manifestation such as
Erythema , edema ,warmth
-Treatment:
-Antibiotic;( IV or IM),ororal.
-Cool, wet dressing on the infection site -
Keeping the area dry and clean -Surgery
-Elevated the affected limb -Rest
-Pain medicine as needed.