TY  - CHAP
M1  - Book, Section
TI  - Surgical Infections
A1  - Beilman, Greg J.
A1  - Dunn, David L.
A2  - Brunicardi, F. Charles
A2  - Andersen, Dana K.
A2  - Billiar, Timothy R.
A2  - Dunn, David L.
A2  - Hunter, John G.
A2  - Matthews, Jeffrey B.
A2  - Pollock, Raphael E.
PY  - 2015
T2  - Schwartz's Principles of Surgery, 10e
AB  - 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.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  in  adequate  source  control  are  associated  with  worsened  outcomes.Principles  relevant  to  appropriate  antibiotic  prophylaxis  for  surgery:  (a)  select  an  agent  with  activity  against  organisms  commonly  found  at  the  site  of  surgery,  (b)  the  initial  dose  of  the  antibiotic  should  be  given  within  30  minutes  prior  to  the  creation  of  the  incision,  (c)  the  antibiotic  should  be  redosed  during  long  operations  based  upon  the  half-life  of  the  agent  to  ensure  adequate  tissue  levels,  and  (d)  the  antibiotic  regimen  should  not  be  continued  for  more  than  24  hours  after  surgery  for  routine  prophylaxis.When  using  antimicrobial  agents  for  therapy  of  serious  infection,  several  principles  should  be  followed:  (a)  identify  likely  sources  of  infection,  (b)  select  an  agent  (or  agents)  that  will  have  efficacy  against  likely  organisms  for  these  sources,  (c)  inadequate  or  delayed  antibiotic  therapy  results  in  increased  mortality,  so  it  is  important  to  begin  therapy  rapidly  with  broader  coverage,  (d)  when  possible,  obtain  cultures  early  and  use  results  to  refine  therapy,  (e)  if  no  infection  is  identified  after  3  days,  strongly  consider  discontinuation  of  antibiotics,  based  upon  the  patient’s  clinical  course,  (f)  discontinue  antibiotics  after  an  appropriate  course  of  therapy.The  incidence  of  surgical  site  infections  can  be  reduced  by  appropriate  patient  preparation,  timely  perioperative  antibiotic  administration,  maintenance  of  perioperative  normothermia  and  normoglycemia,  and  appropriate  wound  management.The  keys  to  good  outcomes  in  patients  with  necrotizing  soft  tissue  infection  are  early  recognition  and  appropriate  debridement  of  infected  tissue  with  repeated  debridement  until  no  further  signs  of  infection  are  present.Transmission  of  HIV  and  other  infections  spread  by  blood  and  body  fluid  from  patient  to  health  care  worker  can  be  minimized  by  observation  of  universal  precautions,  which  include  routine  use  of  barriers  when  anticipating  contact  with  blood  or  body  fluids,  washing  of  hands  and  other  skin  surfaces  immediately  after  contact  with  blood  or  body  fluids,  and  careful  handling  and  disposal  of  sharp  instruments  during  and  after  use.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1117741123
ER  -