Guidelines for the Diagnosis, Treatment and Preventionof Postoperative Infections

Abstract

Bacterial contamination of the operative site is a common occurrence in obstetrics and gynecology. The widespread use of antibiotic prophylaxis has reduced but not eliminated serious postoperative infections. For most operations, a single dose of a limited-spectrum drug has been as effective as a multidose regimen. In the differential diagnosis it is important to consider cellulitis, abscess, necrotizing fasciitis and septic pelvic thrombophlebitis. Abscess and necrotizing fasciitis are expected to require invasive therapy in addition to antibiotics, while cellulitis and septic pelvic thrombophlebitis should respond to medical management alone. Although a postoperative fever is a warning sign of possible infection, it may also be caused by the antibiotics that are given for treatment. The use of prolonged courses of antibiotics once the patient is clinically well is discouraged. While clinical guidelines are provided for use in the diagnosis and management of postoperative infections, these recommendations are intended for general direction and not as an exclusive management plan.

Post partum infections: A review for the non-OBGYN

“…Deep tissue infection may be seen on imaging as collections of fluid or gas in the pelvis following surgery. 10,12 Treatment of wound complications following caesarean section involves antibiotic therapy and source control. Localized infections can be treated empirically with agents directed towards gram-positive organisms such as cefazolin and vancomycin.…”

“…Systemic symptoms of any type warrant treatment with intravenous broad-spectrum antibiotics including gentamicin (5 mg/kg q24 h) and clindamycin (900 mg IV q8 h) plus or minus ampicillin (2 g then 1 g q4 h). Alternatively, a regime with ampicillin, gentamicin, and metronidazole (500 mg q8 h) or levofloxacin (500 mg q24 h) and metronidazole can be effective 12 (see Table 1). All women undergoing caesarean section should receive antibiotic prophylaxis for prevention of wound infection and endometritis.…”

“…All women undergoing caesarean section should receive antibiotic prophylaxis for prevention of wound infection and endometritis. 12,13 A meta-analysis of randomized controlled trails (n ¼ 446 women) comparing a penicillin or cephalosporin with placebo prior to elective caesarean section found a significant reduction in endometritis (RR 0.05 95% CI 0.01-0.38) and postoperative fever (RR 0.25 95% CI of 0.14-0.44).…”

“…12,19 Stepping down to oral antibiotics after resolution of fever, clinical symptoms and leukocytosis has not been shown to decrease recurrence rates. 24 See Table 1 for antibiotic recommendations.…”

Surgical Site Infection After Liver Transplantation: Risk Factors and Association With Graft Loss or Death

“…The frequency and the impact of SSIs on clinical and economic outcomes in nontransplant surgical procedures have driven the development of guidelines for SSI prevention and treatment (5)(6)(7). Simply providing the rates of SSI to surgeons has been associated with reductions in the frequency of SSI (8 -10).…”