Infectious Diseases II

general best-practice guidelines. ACS NSQIP also provides a surgical risk calculator that, depending on the

type of surgery and the patient’s baseline characteristics, can generate estimated risks of complications,

which include pneumonia, cardiac complications, surgical site infections (SSIs), urinary tract infections

(UTIs), venous thromboembolism, renal failure, discharge to a rehabilitation facility, and death. (This risk

calculator can be found at http://riskcalculator.facs.org/.)

sistently high compliance rates. SCIP measure reporting is no longer mandatory. However, the practices

described within the retired SCIP measures still represent best practices and should be continued. These

include administration of an appropriate prophylactic antimicrobial within 1 hour of incision, discontinuation

of the prophylactic antibiotic within a specified time, control of post–cardiac surgery serum blood glucose,

and removal of the urinary catheter by postoperative day 2.

the management of severe sepsis and septic shock can be found in the Shock chapter.

Epidemiology and clinical significance

More than 110,000 SSI cases occur each year.

Mortality rate is 2–11 times higher in patients who experience SSIs than in those who do not.

SSIs account for $4–$10 billion in direct costs and can extend hospital length of stay (LOS) by 9.7

days.

Superficial incisional: Infection involving only the skin or subcutaneous tissue of the incision

Deep incisional: Infection involving fascia and/or muscular layers

Deep incision primary: Wound infection in the primary incision in a patient who has had an

operation with 1 or more incisions

ii.

Deep incision secondary: Wound infection in a secondary incision in a patient who has had an

operation with more than 1 incision

Organ or space: Infection involving any space or organ, opened or manipulated during the procedure,

excluding skin incision, fascia, or muscle layers

Etiology

About 70% to 95% of all SSIs arise from the microbiome of the patient’s skin or nares.

Prevalence of drug-resistant strains (e.g., MRSA, multidrug-resistant gram-negative bacilli) depends

on the local patterns of infection and patient colonization.

The most common bacterial pathogens causing SSI are S aureus, coagulase-negative

staphylococci, Streptococci spp, Enterococcus spp, and E coli. Exogenous bacteria (introduced

by members of the surgical team, the operating room environment, instruments, and materials

brought into the sterile field) include Staphylococci and Streptococci.

ii.

Bacterial pathogens related to anatomic location of the operation:

facultative and anaerobic