Infection in the Post-operative patient

Apr 03, 1978 · The effect of prophylatic cephaloridine on postoperative wound ..
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Diagnosis and Management of Postoperative Infection …

We used multiple logistic-regression analysis to assess the fractional contribution of potentially predictive factors. These included treatment group, study center, sex, age, weight, height, smoking status, physical status as rated on the scale of the American Society of Anesthesiologists, diagnosis, operation site, preoperative hemoglobin concentration and hematocrit, intraoperative use of opioids (fentanyl), postoperative use of opioids (piritramid), intraoperative isoflurane concentration, duration of surgery, and scores on the SENIC and NNISS scales. Factors that had a P value of less than 0.25 on univariate analysis were entered into the mixed-effects model; those that contributed less than 10 percent to the overall ability of the model to predict the incidence of wound infections were sequentially eliminated.

The perioperative administration of supplemental oxygen is a practical method of reducing the incidence of surgical-wound infections.
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Postoperative Deep Wound Infections in Adults ..

Repeated measurements, such as those of tissue oxygen concentration, were averaged over time for each patient and then averaged among the patients in each treatment group. The numbers of postoperative wound infections in each group were analyzed with two-tailed chi-square tests. Other results and potential confounding factors were evaluated with two-tailed chi-square tests, unpaired t-tests, or Mann–Whitney U tests, as appropriate. All P values are two sided.

After a wound culture (a test for bacteria) is taken, an antibiotic will be prescribed if infection is present.
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From July 1996 to October 1998, we enrolled 500 patients, 223 (45 percent) at the Donauspital (Vienna, Austria), 213 (43 percent) at the University of Vienna (Vienna, Austria), and 64 (13 percent) at the University Hospital Eppendorf (Hamburg, Germany). Enrollment in the study was discontinued after 500 patients had been enrolled because the incidence of surgical-wound infection in the two groups differed significantly (P).

In this situation there isclinical evidence of infection and the wound will usually grow the infectiveagent on culture.
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Wound Infection and the Dangers of Sepsis - Advanced …

Cultures should not normally be taken from wounds in theabsence of clinical features of infection, "to find out what isthere", this is a waste of resources and has no clinical application.

Given the relatively low rate of closed-wound infections seen ..

Abdominal wall defects may result from malignancy or trauma. Traumatic abdominal injuries, such as gunshot wounds, are often grossly contaminated and require multiple-stage delayed reconstruction and closure. Abdominal wall infections may result from infections of mesh repairs of abdominal fascia. Mesh infections resist wound care techniques and antibiotic therapy and often present as draining abdominal sinuses. Resolution of the infection usually requires removal of infected mesh and staged abdominal reconstruction.

in prevention of postoperative infections, ..

Meta-analyses have revealed that the ideal suture is nonabsorbable and the ideal closure is continuous. However, many exceptions exist. Healthy thin patients undergoing elective laparotomy for benign conditions may safely have a continuous closure with absorbable sutures. Interrupted absorbable sutures provide better results with fewer complications for contaminated wounds and patients with serious or multiple comorbidities. Additional retention sutures may be required, and closure may be immediate or delayed. Delayed primary closure may reduce infection rates in dirty abdominal wounds compared with primary closure. An interrupted X closure may reduce the risk of dehiscence in patients with risk factors, such as anemia, sepsis, cough, malnutrition, or abdominal distention. It is also important to address patient risk factors for dehiscence preoperatively, if possible.

Wound Infection Medication: Antibiotics

The most highly ranked guidelines were developed by the Scottish Intercollegiate Guidelines Network (SIGN) on Postoperative Management in Adults: A Practical Guide to Postoperative Care for Clinical Staff (2004); Holmes’ Skeletal Pin Site Care: National Association of Orthopaedic Nurses guidelines for Orthopaedic Nursing (2005); McKibben’s Guidance on Public Reporting of Healthcare-associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee (2005); Johnson’s Consensus Recommendations for the Diagnosis, Treatment and Control of Myobacterium Ulcerans Infection (Bainsdale or Buruli Ulcer) in Victoria, Australia (2007).