5. Clinical features
• Patient presents with an area of expanding
erythema with other sign of inflamation
• Fever
• Tense shiny skin
• Toxic look
• Diabetic patient may present with dka
• No edge , no fluctuation ,n pus , no limit
5
6. Necrotising Fascitis
• Rapidly spreading destructive invasion of skin
and soft tissue including deep fascia with
relative sparing of muscles.
• Cause :
type I - Anaerobes , gram negative, colliforms
type II – Group A beta hemolytic streptococci
6
9. Clinical feature
• Sudden swelling and pain with edema
discoloration necrosis and ulceration
• Toxemia
• Foul smelling discharge ( dish water like
watery pus )
• Rapid spread in short period (few hours)
• Feature of mods , sepsis
9
10. Erysepela
• Spreading inflamation of skin and
subcutenous caused by streptococcal pygenes
almost always assocated with cutenous
lymphangitis with development of rose pink
rash with cutenous lymphatic edema
10
11. Site
• Orbit , face , ear lobules
• Hands , scroutum
• Umbilicus in infants
11
13. Non purulent infection
• Mild ( cellulitis /erypesela with no focus of
purulence )
• Moderate (typical cellulitis ,erypesela with
systemic signs of infection )
• Severe ( patients who have failed oral
antibiotics treatment , clinical sign of deep
infection like bulla , sloughing, hypotension,
immunocompromised patients , patient with
systemic signs of inflamation )
13
14. Non purulent infections
Severe
• emergent surgical inspection and
debridement
• rule out Necrotizing fascitis
• emperical antibiotics Vancomycin +
pireracillin /tazobactam)
• culture and sensitivity
14
19. Carbuncle
• infective gangrene of subcutenous tissue
• Causative agent :staph. Aureus
• Common in diabetic and
immunocompromised
• Site : nape of neck , back , shoulder
19
20. Clinical feature
• Red hot coal like appearance
• Indurated surrounding
• Later on cribiform appearance and crateriform
ulcer.
20
25. Specific treatment
• Moderate
MSSA : TMP/SMX
MRSA : DICLOXACILLIN , CEFALEXIN
• SEVERE
MSSA : NAFCILLIN , CEFAZOLIN , CLINAMYCIN
MRSA : THOSE IN EMPERICAL
25
26. SURGICAL SITE INFECTION
Superficial
• involve only the subcutaneous space,
• occur within 30 days of the surgery,
• documented with at least 1 of the following:
(1) purulent incisional drainage,
(2) positive culture of aseptically obtained fluid or tissue from
the superficial wound,
(3) local signs and symptoms of pain or tenderness, swelling,
and erythema after the incision is opened by the surgeon
(unless culture negative)
(4) diagnosis of SSI by the attending surgeon or physician
based on their experience and expert opinion.
26
27. Deep incisional infection
• involves the deeper soft tissue (eg, fascia and
muscle)
• occurs within 30 days of the operation or
within 1 year if a prosthesis was inserted
• has the same findings as described for a
superficial
27
28. organ/space SSI
• has the same time constraints and evidence for
infection as a deep incisional SSI,
• involve any part of the anatomy (organs or
spaces) other than the original surgical incision
• postoperative peritonitis, empyema, or joint space
infection
• Any deep SSI that does not resolve in the
expected manner following treatment should be
investigated as a possible superficial
manifestation of a deeper organ/space infection.
28
29. • Local signs of pain, swelling, erythema, and purulent
drainage provide the most reliable information in
diagnosing an SSI.
• In morbidly obese patients or in those with deep,
multilayer external signs of SSI may be delayed.
• While many patients with a SSI will develop fever, it
usually does not occur immediately postoperatively,
and in fact, most postoperative fevers are not associated
with an SSI
• Flat, erythematous skin changes can occur around or
near a surgical incision during the first week without
swelling or wound drainage.
29
30. • Most resolve without any treatment.
• The cause is unknown but may relate to tape
sensitivity or other local tissue insult not
involving bacteria.
• antibiotics begun immediately postoperatively or
continued for long periods after the procedure do
not prevent or cure this inflammation or infection
• Therefore, the suspicion of possible SSI does not
justify use of antibiotics without a definitive
diagnosis and the institution of other therapeutic
measures such as opening the wound
30
32. • Suture removal plus incision and drainage
• Adjunctive systemic antimicrobial therapy in
conjunction with incision and drainage for
surgical site infections associated with a
significant systemic response
• ( such as erythema and induration extending >5
cm from the wound edge, temperature >38.5°C,
heart rate >110 beats/minute, or white blood cell
(WBC) count >12 000/µL (weak, low).
32
33. • A brief course of systemic antimicrobial therapy is
indicated in patients with surgical site infections
following clean operations on the trunk, head and
neck, or extremities that also have systemic signs of
infection
• A first-generation cephalosporin or an
antistaphylococcal penicillin for MSSA, or vancomycin,
linezolid, daptomycin, telavancin, or ceftaroline where
risk factors for MRSA are high (nasal colonization, prior
MRSA infection, recent hospitalization, recent
antibiotics
33
34. • Agents active against gram-negative bacteria
and anaerobes, such as a cephalosporin or
fluoroquinolone in combination with
metronidazole, are recommended for
infections following operations on the axilla,
gastrointestinal tract, perineum, or female
genital tract
34
