SU6.1-2 | Surgical Infection and Antibiotic Management — Summary & Reflection

KEY TAKEAWAYS

A surgical infection is one that needs surgical treatment or follows surgery. Whether it develops is a balance (Cruse-Foord): the dose and virulence of contaminating organisms versus host resistance and the local wound environment — so it is largely preventable by optimising the host, the environment and asepsis. The usual organisms are Staphylococcus aureus (incl. MRSA), streptococci (cellulitis), coliforms and Bacteroides (after GI surgery), Clostridium (gas gangrene, tetanus) and Pseudomonas (burns, hospital-acquired). The types to recognise are surgical-site infection (superficial/deep incisional, organ/space), cellulitis (spreading, antibiotic-responsive), abscess (drainable pus — drainage is essential), and the emergencies necrotizing fasciitis and gas gangrene (immediate radical debridement). Management has two pillars in fixed order: source control first — drainage, debridement, removal of infected material — then antibiotics, used either prophylactically (single IV dose within 60 minutes before incision, re-dose for long operations, stop within 24 hours) or therapeutically (empirical after cultures, then de-escalated, always adjunctive to source control). Be able to enumerate the antibiotic classes and choose by likely organism, site and resistance.

REFLECT

Think back to a surgical infection you have seen — a wound that broke down and discharged pus, an abscess that needed draining, or a severe spreading infection. Could you have explained, at the time, why that particular patient became infected in terms of the pathogen, the host and the wound environment? Was the management ordered correctly — was the source controlled (drained or debrided) before reliance on antibiotics, or were antibiotics used as a substitute? If prophylactic antibiotics were given for an operation, were they given at the right time and stopped promptly? How will understanding the primacy of source control, and the discipline of rational antibiotic use, change how you anticipate, recognise and treat the next surgical infection you meet?