Infectious Diseases I
the Infectious Diseases II chapter.
Postoperative wound infections most commonly occur 48 hours after the procedure. Fever in the first
48 hours is usually idiopathic or from noninfectious causes.
aseptically and sent for Gram stain and culture. Cultures in patients with suspected deep tissue
infections should be obtained from deep tissues with concomitant blood cultures.
Signs and symptoms of superficial incisional postoperative wound infection include:
Purulent incisional drainage
Local pain or tenderness, swelling, and erythema after the incision is opened
Positive culture of purulent drainage
Necrotizing fasciitis should be suspected if the following are present:
Severe pain that seems disproportional to the appearance of the wound
Failure to respond to initial antibiotic therapy
Hard, wooden feel of the subcutaneous tissue, often extending beyond the area of affected skin
| d. | Crepitus on physical examination or radiographic (radiograph, CT scan) finding, indicating gas in |
|---|
subcutaneous tissues
Skin necrosis or ecchymoses
Sepsis or septic shock
Opening of the incision, evacuation of the infected material, and continued dressing changes are the
foundation of treatment for confirmed postoperative wound infections.
and symptoms or suspected deep tissue infection.
Superficial incisional infection
Erythema and induration less than 5 cm and minimal systemic signs of infection (no fever, no
leukocytosis, and tachycardia):
Serial dressing changes
ii.
No antibiotic therapy necessary
iii.
Continue to assess wound for resolution or progression.
Erythema and induration greater than 5 cm, fever, leukocytosis, and tachycardia:
Open suture line.
ii.
Initiate empiric antibiotic therapy targeted against operative site–related suspected pathogens.
Examples include:
| (a) | Extremity, head, neck, or trunk site: Cefazolin or vancomycin if MRSA suspected |
|---|---|
| (b) | GI, genitalia, or perineum site: Cephalosporin or levofloxacin plus metronidazole; |
ertapenem
iii.
Adjust antibiotics according to culture results. Continue for up to 48 hours or until infection
is resolved.
iv.
Serial dressing changes
Continue to assess wound for resolution or progression.
Necrotizing fasciitis
Surgical debridement of necrotic tissue serially (i.e., every 24–48 hours) until no further need for
debridement