Surgery - Surgical Infection & Antibiotics Flashcards Preview

CP3 @ UoN - Medicine & Surgery > Surgery - Surgical Infection & Antibiotics > Flashcards

Flashcards in Surgery - Surgical Infection & Antibiotics Deck (48):
1

What general factors contribute to wound infection following a surgical procedure?

Age
Malnutrition
Immunosuppression
Malignancy
Obesity
Hypoxia
Anaemia

2

What local factors contribute to wound infection following a surgical procedure?

Type of surgery (clean vs contaminated)
Length of procedure
Residual local malignancy
Foreign body insertion
Ischaemia

3

What microbiological factors contribute to wound infection following a surgical procedure?

Lack of a/b prophylaxis
Virulence of organism

4

What are the four types of operative procedure, in reference to their potential for infectious complications?

Clean
Potentially-contaminated
Contaminated
Dirty

5

Describe a clean operative procedure

Operation does not enter colonised viscus or lumen of body
SSI risk from contaminants from environment (2-5%)
-S. aureus most common

6

Describe a potentially-contaminated procedure

Operation enters colonised viscus or body cavity but under elective & controlled conditions
SSI risk from endogenous bacteria (10%)

7

Describe a contaminated procedure

Contamination present at surgical site w/o obvious infection
SSI risk from endogenous bacteria (20%)

8

Describe a dirty procedure

Surgery performed where active infection already present
SSI risk from established pathogens (30%)

9

What are the three types of surgical site infection?

Superficial Incisional
Deep Incisional
Organ/space

10

What is a Superficial Incisional SSI?

Infection of skin & s.c. tissue of incision

11

What is a Deep Incisional SSI?

Infection of deep tissues (muscle/fascial) and includes organ/space SSIs draining through the incision

12

What is an Organ/Space SSI?

Infection of any site involved in the operation other than the incision

13

Which patients should be given prophylactic infection?

Pts at high risk of infection
Pts where an infection would be serious, even if risk is low

14

What determines choice of antibiotic in surgical pts?

Likely infecting organisms
Hospital guidelines
-cefuroxime & metronidazole

15

What is impetigo?

Superficial purulent infection caused by staph/strep w/ golden crust on erythematous base

16

How should impetigo be managed?

Swab to confirm organism
Treat w/ topical mupirocin/fusidic acid

17

What is ecthyma?

Purulent skin infection caused by staph/strep. Ulceration under a crust

18

How should ecthyma be managed?

Associated w/ poor hygiene & malnutrition
Treat by guidelines

19

What is erythrasma?

Mildly itchy eruption b/w toes/flexures caused by corynebacterium

20

How should erythrasma be managed?

Topical miconazole OR
Oral erythromycin

21

What is Folliculitis?

Pustular infection caused by staph
-can be deep or superficial

22

How should folliculitis be managed?

Oral flucloxacillin (if superficial)
Tetracycline/erythromycin (if deep)

23

What is Staphylococcal Scalded Skin Syndrome?

Fever, irritability & skin tenderness THEN
Erythema & blistering (after 24-48hrs)

24

How should SSSS be managed?

Bacterial swab from nose/throat
IV flucloxacillin

25

What is Cellulitis?

Infection of s.c. tissue due to staph

26

What is Erysipelas?

Infection of dermis due to staph
Raised erythematous edge
Often on face

27

What are Viral Warts?

Smooth, skin coloured papules w/ irregular hyperkeratotic surface
-resolve spontaneously

28

What is Molluscum Contagiosum?

Poxvirus causing umbilicated papules
-resolve spontaneously over months

29

What is Ringworm?

Erythematous annular lesions w/ central clearing

30

How should Ringworm be managed?

Topical terbinafine/ketoconazole
-may be systemic in widespread disease

31

What is Scabies?

Scabietic burrows on edges of fingers/sides of hands/feet

32

How should Scabies be managed?

Topical permethrin/malathion
-give to all physical contacts

33

What are the two broad types of gangrene?

Anaerobic
Synergistic (necrotising fasciitis)

34

What causes anaerobic gangrene?

Clostridium perfringens in soil/faeces
-arises from trivial injury
-often in immunocompromised pts

35

How does anaerobic gangrene present?

Gas in tissues & skm (crepitus)
Oedema
Spreading gangrene w/ systemic upset

36

How should anaerobic gangrene be managed?

Resuscitation
Aggressive debridement
IV penicillin + metronidazole

37

What causes synergistic gangrene?

Aerobes & synergistic anaerobes infect wound/surgical site

38

How does synergistic gangrene present?

Severe wound pain
Gas in tissues
Extensive subdermal gangrene

39

How should synergistic gangrene be managed?

Debridement
Antibiotics
Systemic support

40

What are the causes of post-op fever?

Mild pyrexia common post-op (response to tissue injury/stress)
Severe pyrexia (infection)

41

What general steps should be taken when reviewing a patient with post-op fever?

Review general obs, urine output etc.
Inspect wound for SSI/haematoma
Inspect cannula sites for thrombophlebitis/infection
Examine chest for infection/infarction/acute heart failure
Examine legs for DVT
Consider other sources of infection

42

When is a routine isolation unit used?

Protect other pts/staff from pts infection

43

When are reverse isolation units used?

Protect pts from infections carried by staff/visitors/pts
-used when pts have decreased immunity

44

What are the common locations of an intra-abdominal abscesses?

Alongside organ of origin
Pelvic
Subphrenic

45

What are the clinical features of an intra-abdominal abscesses?

Malaise
Anorexia
Swinging pyrexia
Tachycardia
Possible mass

46

How are intra-abdominal abscesses investigated?

CT abdo/pelvis

47

How are intra-abdominal abscesses managed?

IV empirical a/b
Radiologically guided drainage
-surgical drainage as last line

48

How should a superficial s.c. abscess be drained?

Performed under GA
Fluctuance incised
Blunt probing ensures all loculi drained

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