1. Soft tissue infections Done by : Abdulhadi T. Gelaidan Supervised by ; Dr.Majed Mansouri

2. Content of lecture: Antibiotics use

3. Content of lecture: Antibiotics use Relation between infection and body.

4. Content of lecture: Antibiotics use Relation between infection and body. Important bacteria in General surgery.

5. Content of lecture: Antibiotics use Relation between infection and body. Important bacteria in General surgery. Important antibiotics in G.S.

6. Content of lecture: Antibiotics use Relation between infection and body. Important bacteria in General surgery. Important antibiotics in G.S. Types of soft tissue infections

7. Antibiotics use Prophylaxis : indications - Increase in risk of infect. -Wound classes. -Infection = Disaster e.g : infected heart valve

8. What are the risk of infection?

9. Wound classes Immune deficiency Medications steroids Chronic illness Nutritions Old Age What are the risk of infection?

10. Wound classifications

11. Clean wounds

12. Wound classifications Clean wounds Clean-contaminated

13. Wound classifications Clean wounds Clean-contaminated Contaminated

14. Wound classifications Clean wounds Clean-contaminated Contaminated Dirty

15. Risk of infection Wound classes Immune deficiency Medications steroids Chronic illness Nutritions Old Age

16. Risk of infection 1-Host : -Diet – vit.C. -Extreme age. -Chronic illness. -D.M, CLD, CRF -Medications: Steroid -Impaired immunity: HIV 2-Infection agent : 3-Battle ground wound : -Ischemia -Necrosis -Gangreneous -Decrease WBC,Abs -Virulence -Numbers

17. 1-Host : -Diet – vit.C. -Extreme age. -Chronic illness. -D.M, CLD, CRF -Medications: Steroid -Impaired immunity: HIV Risk of infection 2-Infection agent : 3-Battle ground wound : -Ischemia -Necrosis -Gangreneous -Decrease WBC,Abs -Virulence -Numbers

18. Risk of infection 1-Host : -Diet – vit.C. -Extreme age. -Chronic illness. -D.M, CLD, CRF -Medications: Steroid -Impaired immunity: HIV 2-Infection agent : 3-Battle ground wound : -Ischemia -Necrosis -Gangreneous -Decrease WBC,Abs -Virulence -Numbers

19. Risk of infection 1-Host : -Diet – vit.C. -Extreme age. -Chronic illness. -D.M, CLD, CRF -Medications: Steroid -Impaired immunity: HIV 2-Infection agent : 3-Battle ground wound : -Ischemia -Necrosis -Gangreneous -Decrease WBC,Abs -Virulence -Numbers

20. Important Bacteria in G.S COCCiBACILLI Gram + ve : Gram – ve Gram – ve : Gram + ve Gram + ve : Gram – ve Gram – ve :

21. Important Bacteria in G.S COCCiBACILLI Gram + ve : Gram – ve Gram – ve : Gram + ve Gram + ve : Gram – ve Gram – ve : Gram + ve : - Stapylococci -Streptcocci -Enterococcus -Peptostreptococcus

22. Important Bacteria in G.S COCCiBACILLI Gram + ve : Gram + ve Gram + ve : Gram – ve Gram – ve : Gram + ve : - Stapylococci -Streptcocci -Enterococcus -Peptostreptococcus Gram – ve : -Acinetobacter -Moraxella -Neisseria

23. Important Bacteria in G.S COCCiBACILLI Gram + ve : Gram – ve Gram – ve : Gram + ve : - Stapylococci -Streptcocci -Enterococcus -Peptostreptococcus Gram – ve : -Acinetobacter -Moraxella -Neisseria Gram + ve : -bacillus -clostridium -corynebacterium -lactobacillus -Listeria -Propinobacterium

24. Important Bacteria in G.S COCCiBACILLI Gram + ve : - Stapylococci -Streptcocci -Enterococcus -Peptostreptococcus Gram – ve : -Acinetobacter -Moraxella -Neisseria Gram – ve : -Pseudomonas -E.coli -Shigella -Salmonella -Klebsilla -Bacteroids -Helicobacter -Campylobactur -Fusobacterium -Proteus -Prevottella -Providencia -Serratia -Vibrio -Yersinia -Bartonella -Bordetella -Brucella -Francisella -Hemophilus -Legionella -Pasteurella Gram + ve : -bacillus -clostridium -corynebacterium -lactobacillus -Listeria -Propinobacterium

25. Important Bacteria in G.S G+ve Anaerobic Clostridium tetani - Clostridium tetani - Clostridium perfringes - Clostridium defficuili - Clostridium botulinium -Bacteroides -Fusobacterium -Prevotella G-ve Anaerobic

26. Common antibiotics Antibiotics PenecillinCephalosporineAminoglycosidescarmabenumFluoroquinolones Others -Combined Tazocine Tazopactum Bactrim Septrin Macrolides

27. Penecillins Bacteria coverage : Gram (+) Cocci, C.perfringens. Used in: cellulites & carbuncle Synthetic & combined

28. But what are the problem with PENECILLINS ?

29. Limited spectrum

30. But what are the problem with PENECILLINS ? Limited spectrum Resistance

31. Cephalosporine Action: cell wall inhibitors. Cephalosporines 1 st generation Cefazoline Cephalexin cefadroxil Mainly Gram + 2 nd gene. PC-TRX Cefprozil PO Cefaclor Cefotetan Cefuroxime I.M-I.V Cefoxitin G-,G+,Anaerobic Mainly Gram - 3 rd gene. Any cef. Out of PC-TRX Ceftazidime which Pass through BBB G-,Anaerobic 4 th gene. Cefepime Pseudomonus, Anaerobic

32. Aminoglycosides Bacteria coverage : G (+)cocci & G ( - )bacilli Sub group : Gentamicin, Tobramycin,Amikacin,Neomycin,Streptomycin Execreted by: kidney Side effects: Renal toxicity and Ototoxicity

33. Nalidixic acid,Ciprofloxacine, Norfloxacin, Ofloxacin,Moxifloxacin,Levofloxacin G(- ve) Most active against pseudomonas Subtypes: Azithromycine, Erythromycine, Clarithromycin,Telithromycin Bacteria coverage : G (+)cocci & G ( - )bacilli Macrolides Fluoroquinolones

34. Bacteria coverage : Broad spectrum Subtypes: merupenum - imipenem Contra indication: panceriatitis-seizure – not allowed to given by doctors less than R5 Carbapenems

35. Clindamycine Bacteria coverage: Anaerobic & G +ve cocci

36. Vancomycine Bacteria coverage : MRSA,G + ve. Used in: prosthetic valve,dialysis catheter

37. Augmantin combination antibiotic containing amoxicillin trihydrate, a β- lactam antibiotic, with potassium clavulanate, a β- lactamase inhibitor. This combination results in an antibiotic with an increased spectrum of action and restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.antibioticamoxicillin trihydrateβ- lactam antibioticpotassium clavulanateβ- lactamase

38. Bactrim (septrin) combination of trimethoprim and sulfamethoxazoletrimethoprim sulfamethoxazole

39. Tazocin Piperacillin is an extended spectrum beta-lactam antibiotic of the ureidopenicillin class.extended spectrum beta-lactam antibioticureidopenicillin It is normally used together with a beta-lactamase inhibitor such as tazobactam. The combination drug of piperacillin and tazobactambeta-lactamase inhibitortazobactam Its main uses are in intensive care medicine (pneumonia, peritonitis), some diabetes-related foot infections and empirical therapy in febrile neutropenia (e.g. after chemotherapy).intensive care medicinepneumonia peritonitisdiabetes-related foot infectionsfebrile neutropenia chemotherapy

40. Soft tissue infections Superficial (skin and subcutanous) :- -Boils -Folliculitis -Impetigo -Erysipelas -Cellulitis -Abcess -Carbuncle Deep ( Fascia & Muscle) :- -Necrotizing Fasciitis -Gas gangrene Organs :- -Cholecystitis -Appendicitis

41. Soft tissue infections

42. Superficial (skin and subcutanous) 1- Boils : it is infection of single hair follicle 2- Folliculitis Folliculitis is a infection of group of hair follicles;

43. Impetigo 3- Impetigo : staphylococcus, streptoccus infection which presented with honey crust skin after blisters rupture. Rx : by direct washing, topical Abcs, oral Abcs

44. Erysipelas 4 –(localized cellulitis) sharply demarcated streptcoccal infection of lymphatic vessels, usually associated with broken skin on face, erythema, Oedema do --- C/S Rx : broad spectrum Abcs

45. 5-Cellulitis - Is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken.inflammationconnective tissueskinskin flora exogenous bacteria

46. 6-Skin Abcess - Is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue in which the pus resides on the basis of an infectious process (usually caused by bacteria or parasites)pusneutrophilsinfectiousbacteriaparasites

47. 7-Carbuncle - Is an abscess larger than a boil, usually with one or more openings draining pus onto the skin.abscess boilpus skin

48. Deep ( Muscle & Fascia) 1- Necrotizing fasciitis : Flesh-eating disease or Flesh-eating bacteria syndrome, is a infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissueinfectionskin subcutaneous tissues fascial

49. 2 – Gas gangrene : is a bacterial infection that produces gas tissues in gangrene. It is a deadly form of gangrene usually caused by anaerobic bacteria. It is a medical emergency.bacterialinfectiongastissuesgangrene medical emergency Deep ( Muscle & Fascia)

51. Deep organs -Appendicitis. -Acute cholecystitis