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Introduction
Sepsis is both the presence of infection and the host
response to infection (systemic inflammatory response
syndrome, SIRS).
Sepsis is a clinical spectrum, ranging from sepsis (SIRS
plus infection) to severe sepsis (organ dysfunction), to
septic shock (hypotension requiring vasopressors).
Outcomes in patients with sepsis are improved with an
organized approach to therapy that includes rapid
resuscitation, antibiotics, and source control.
introduction
Source control is a key concept in the treatment of most
surgically relevant infections.
Infected or necrotic material must be drained or
removed as part of the treatment plan in this setting.
Delays inadequate source control are associated with
Worsened outcomes
Pathogenesis of Infection
Host Defenses
skin or subcutaneous tissue are common. The mammalian
host
possesses several layers of endogenous defense
mechanisms that serve to prevent microbial invasion, limit
proliferation of microbes within the host, and contain or
eradicate invading microbes.
Infection is defined by the presence of microorganisms
in host tissue or the bloodstream. At the site of infection
the classic findings of rubor, calor, and dolor in areas such as
the skin or subcutaneous tissue are common
Arterial hypoxemia
Acute oliguria
Creatinine increase
Coagulation abnormalities
Ileus
Thrombocytopenia
Hyperbilirubinemia
Microbiology Of Infectious
Agents
Bacteria are responsible for the majority of surgical
infections. Specific species are identified using Grams
stain and growth characteristics on specific media.
Bacteria are classified based upon a number of
additional characteristics, including morphology (cocci
and bacilli), the pattern of division (e.g., single
organisms, groups of organisms in pairs [diplococci],
clusters [staphylococci], and chains [streptococci]), and
the presence and location of spores
Microbiology Of Infectious
Agents
Fungi
Fungi typically are identified by use of special stains (e.g.,
potassium hydroxide (KOH), India ink, methenamine silver, or
Giemsa). Initial identification is assisted by observation of the
form of branching and septation in stained specimens or in
culture.
Viruses
Viral infection was identified by indirect means (i.e., the host
antibody response).
Surgical wounds
Classified based on the presumed magnitude of
the bacterial load at the time of surgery:
Clean wounds (class I) include those in which no
infection is present; only skin microflora potentially
contaminate the wound, and no hollow viscus that
contains microbes is entered.
Class I D wounds are similar except that a prosthetic device
(e.g., mesh or valve) is inserted.
and
operating
room
environment)
and
conclusion
The incidence of surgical site infections can be reduced by:
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