1. Surgical Infection Dr. Weiguo Hu 胡伟国 Dr. Weihua Qiu 邱伟华 Department of Surgery Rui Jin Hospital Shanghai Jiao Tong University School of Medicine

2. Definition Classifications Etiology Clinical Manifestation Management Specific Surgical Infections Characteristics of Hand Infections Key Points ：

3. Infections be treated by surgical intervention Infections following surgical procedure (wound or distant site) Definition ：

4. Non-specific infection Furuncle & Carbuncle Cellulitis & Erysipelas Hand infection Acute appendicitis Acute peritonitis Breast abscess Classifications ： Characteristic

5. Specific infection Tuberculosis Fungal infection Tetanus Gas gangrene Classifications ： Characteristic

6. Acute infection (<3w) Most non-specific infection Tetanus Gas gangrene Chronic infection (>2M) Tuberculosis Sub-acute infection (3w-2M) Urine tract infection Fungal infection Classifications ： Course of Disease

7. Classifications ： Others Opportunistic Infection Superinfection Nosocomial Infection

8. Local phase Skin infection Soft-tissue infection Hand infection Abscess Systemic phase Bacteremia Sepsis Classifications ： Others

9. Bacteria Virus Fungi Endotoxin Ectotoxin Enzyme Etiology ： Pathogenic Microorgansim

10. Trauma Ischemia and Hypoxia Obstruction Presence of Foreign Bodies and Necrotic Tissues Ionizing Radiation Edema Etiology ： Local Factors

11. Severe Trauma DM Cancer, Chemotherapy Leukemia AIDS Immunodeficiency Malnutrition Etiology ： Systemic Factors

12. Cure Dissemination Abscess formation Bacteriamia & Sepsis & SIRS & MODS Chronic infection Results ： Non-specific Infections

13. Mixed infection Tuberculosis Systemic infection Tetanus, gas gangrene Opportunistic infection Fungi Results ： Specific Infections

14. Localized surgical infection Redness Swelling Pain Heat Loss of function Clinical Manifestation ：

15. Localized surgical infection Clinical Manifestation ： Fever Chills Tachycardia Leukocytosis & left shift of WBCs

16. Synergistic Gangrene caused by streptococci & staphylococci (self-injection with heroin)

17. Severe Systemic Infection (Gram-positive) Clinical Manifestation ： Chill, Fever Flushing Warm Extremities Metastatic abscess Shock in late phase

18. Severe Systemic Infection (Gram-negative) Clinical Manifestation ： Chill, Fever Cold Extremities Shock in early phase Oliguria High-output heart failure Disturbed sensorium

19. Diagnosis ： HPI Physical Examination General Condition Regional Symptoms Mal-function of Related Organs Characteristic Manifestations

20. Diagnosis ： Lab Test CBC Culture Sensitivity Test Others CT Ultrasonic X-ray

21. Intravenous cannula---purulent drainage or thrombophlebitis Rectal examination---pelvic abscess Auscultation of chest---pneumonia Physical Exam ：

22. Accumulation of extracellular fluid Color, odor, character Be useful in categorizing the causative organism Gram stain an essential procedure for diagnosis and treatment Physical Exam ： Exudate

23. Breast abscess

24. Being necessary for diagnosis sometimes Especially for granulomatous infection Tuberculosis blastomycosis Physical Exam ： Biopsy

25. Exudate the most reliable diagnosis for treatment Both aerobic and anaerobic culture Blood Diagnostic step for unknown source Fail to capture causative organisms in bacteremia Unnecessary to diagnose sepsis Sputum Urine Culture ：

26. Management ： General Supporting Temperature Control Management of Water and Electrolytes Balance Nutrition Supplement Hypoalbuminemia Uderlying Factors Vital Signs Monitor

27. Management ： Immobilization of the infection area Effective local care Relief of swelling & pain Proper Dressing Physical Therapy to increase local blood supply to facilitate exudation

28. Management ： Surgical Therapy Debridement of Infected or necrotic tissues Harboring foreign objects & microorgnisms Poor blood supply Decreasing host resistance Skin Grafting Paracentesis Drainage of Abscess Removal of Foreign Body

29. Simple appendicitis treated by early operation

30. Neglected, perforated appendicitis with a complex lower abdominal abscess associated with necrosis of adjacent tissue

31. Principle of Antibiotics Management:

32. Acute sever trauma and infection Prophylactic Management Indications:

33. Bacteriostatic agents Prevent growth of bacteria Bacteriocidal agents Actually kill bacteria Management ： Antibiotics

34. Effective agent against the infecting organism Adequate contact between agent and organism Absence of toxic side effect of the agent Augmentation of host defenses to maximize antibacterial effects Management ： Antibiotics

35. Culture before antibiotic therapy Administer antibiotics on empiric basis before the laboratory reports Culture and sensitivity test (Evidence basis) a combination of antibiotics for probable polymicrobic infection Management ： Antibiotics

36. Colonization The quantitative appearance of changes in the microflora that are induced by antibiotic therapy Superinfection A new microbial disease introduced or potentiated by antibiotic therapy Superinfection is frequently the result of colonization. Colonization & Superinfection:

37. for potentially contaminated wounds Only an adjunct and NOT a substitute to good surgical technique Antibiotic Prophylaxis

38. Clean procedure no antibiotics are necessary Clean contaminated procedure Contact of the interior of respiratory, urinary,GI tracts Contaminated procedure Complicated by gross spillage of intestinal contents or wounds secondary to trauma Dirty wounds In contact with intraabdominal or perirectal abscess Antibiotic Prophylaxis

39. Malnourished Obese Elderly Immunodeficient Shock or MOF Poor blood supply to the operative region Antibiotic Prophylaxis

40. early and enough for adequate tissue and body fluid levels Being necessary to maintain adequate tissue levels intra-operatively length of operation and serum half-life of antibiotics Antibiotic Prophylaxis

41. Cellular site of inhibitionBacteriocidalBacteriostatic Cell wall synthesispenicillin cephalosporins vancomycin Barrier function of cell membrane amphotericin Bnystatin polymyxin Protein synthesis in ribosomeaminoglycosidestetracycline chloramphenicol Erythromycin clindamycin DNA replicationGriseofulvin

42. Thanks!

43. Being best treated by operative intervention Being following surgical procedure (wound or distant site) Definition ：

44. Superficial wound infection due to hemolytic Streptococci Localized surgical infection Clinical Manifestation ：