Professional Documents
Culture Documents
Kochs postulates
It must be found in considerable numbers in the septic focus It should be possible to culture it in a pure form from that septic focus It should be able to produce similar lesions when injected into another host
History
Ignac Semmelweis :
sepsis could be reduced by the simple act of hand-washing
Alexander Fleming:
Discovery of the antibiotic penicilin
Physiology
Protective Mechanism to Prevent Infection: Mechanical: epithelial surfaces chemical: low gastric pH; humoral: antibodies, complement and opsonins; cellular: phagocytic cells, macrophages, polymorphonuclear cells and killer lymphocytes
All these natural mechanisms may be compromised by surgical intervention and treatment.
Abscesses
Abscesses need drainage with curettage Modern imaging techniques may allow guided aspiration Antibiotics are indicated if the abscess is not localised (e.g. evidence of cellulitis) Healing by secondary intention is encouraged
Abscesses
Technique of Incision and Drainage
Place a latex drain into the depth of the cavity. Fix the drain to the edge of the wound with a suture and leave in place until the drainage is minimal. Alternatively, pack the cavity open, place several layers of damp saline or petroleum gauze in the cavity leaving one end outside the wound
Gas gangrene
Caused by Clostridium perfringens Gas and smell are characteristic Immunocompromised patients are most at risk Antibiotic prophylaxis is essential when performing amputations to remove dead tissue
Clostridium tetani
anaerobic, Gram-positive bacterium more common in traumatic civilian or military wounds. The signs and symptoms of tetanus are mediated by the release of the exotoxin tetanospasmin high mortality Prophylaxis with tetanus toxoid
The wound is open, and the edges are not approximated. A potentially contaminated wound is best left open lightly packed with damp saline soaked gauze and the suture closed as delayed primary closure after 25 days
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