Infections In Surgery

Although most clinicians are aware of the problem of antimicrobial resistance, most also underestimate its significance in their own hospital. The incorrect and inappropriate use of antibiotics and other antimicrobials, as well as poor prevention and poor control of infections, are contributing to the development of such resistance. Appropriate use of antibiotics and compliance with infection prevention and control measures should be integral aspects of good clinical practice and standards of care. However, these activities are often inadequate among clinicians, and there is a considerable gap between the best evidence and actual clinical practice. In hospitals, cultural determinants influence clinical practice, and improving behaviour in terms of infection prevention and antibiotics-prescribing practice remains a challenge. Despite evidence supporting the effectiveness of best practices, many clinicians fail to implement them, and evidence-based processes and practices that are known to optimize both the prevention and the treatment of infections tend to be underused. Addressing precisely this problem, this volume offers an essential toolkit for all surgeons and intensivists interested in improving their clinical practices.

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between £814 and £6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US $10 billion per year. No international evidence-based guidelines had previously been available before WHO launched its global guidelines on the prevention of surgical site infection on 3 November 2016, and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

Microbiology for Surgical Infections: Diagnosis, Prognosis and Treatment explores current trends in etiology and antibiotic resistance of pathogens responsible for devastating and complex surgical infections. Clinicians and researchers report the most recent advances in diagnostic approaches to bacterial and non-bacterial surgical infections, including invasive fungal infections. Current guidelines for prophylaxis of community-acquired and nosocomial infections, complications in surgery, and improvement of diagnosis and treatment of these devastating surgical infections are also discussed. The work gives specific attention to intra-abdominal and wound infections, as well as infections in cardiac surgery and neurosurgery. Taken together, these explorations inform the work of specialists in different surgical arenas, as well as those working in microbiology. Microbiology for Surgical Infections provides a resource to those working to improve outcomes in this complicated arena by discussing prospects for future study and identifying targets for future research. Provides a multi-dimensional view of myriad topics pertinent to surgical infections, including questions of etiology, pathogenesis, host-microbial interactions, diagnosis, prognosis, treatment and prophylaxis Delivers cutting-edge commentary from eminent surgeons, microbiologists, and infectious disease specialists, with global contributions from both the developed and developing worlds Presents comprehensive research informed by the most recent technological and scientific advances in the field

Complications in Small Animal Surgery provides a completereference to diagnosing, managing, and treating surgicalcomplications, with information following a standardized format forease of use. • Presents comprehensive information ondiagnosing, managing, and preventing surgical complications usingan accessible format • Offers a well-defined, thoroughlyillustrated format to maximize practical value, with algorithms,tables, practical tips, and many images throughout • Covers common and uncommon complicationsin all body systems • Serves as a reference to recentliterature relevant to each complication • Includes access to a companion websitewith videos, figures from the book available for download intoPowerPoint, and linked references atwww.wiley.com/go/griffon/complications

This Atlas is the first reference Atlas covering exclusively all aspects of this multifaceted topic. It is designed to serve as a succinct appropriate resource for neurosurgeons, spinal surgeons, radiologists, neurologists, microbiologists, researchers and infectious disease specialists with an interest in cranio-cerebral and vertebro-medullary infections especially encountered in neurosurgery and spinal surgery. This Atlas is designed to deliver more information in less space than traditional texts, allowing for quick review of the essential facts of this complex infectious topic through pictures. Pertinent imaging and laboratory information are combined with intraoperative photographs and illustrations to help readers visualize variable presentations and enhance their perioperative management. The comprehensive content of this richly-illustrated book covers different infectious diseases seen on neurosurgical and spinal practices. The Atlas is divided into five sections, after a general introduction, the second section focuses on infections of the brain and its coverings. The third section focuses on vertebromedullary infections. The fourth section includes infections following cranial and spinal surgery, and the fifth section provides a description of the most important specific pathogens and other particular conditions. The format makes it easily accessible and includes a definition of each infection and its epidemiology, main clinical presentations, imaging features and laboratory findings, treatment options, and prognosis information. It will help the reader in choosing the most appropriate way to manage this multipart problem. In addition, the book supplies clinicians and investigators with both basic and more sophisticated information and procedures relating to the complications associated with neurosurgical and spinal infections.

Source control is the key to the management of surgical infections. Surgical decision making is based on the marriage of evidence from clinical studies, inferences from biology, and the elusive component of surgical experience; this book combines these three elements. We have recruited an international group of authors who are acknowledged leaders in the field of surgical infectious diseases. We have challenged them to integrate evidence with experience and an understanding of biology so as to create overviews that will help the clinician who must make the difficult decisions. And we have kept them honest by asking a second group of equally eminent commentators to provide supporting or alternative views - in essence, to recreate the kind of dialogue that takes place between clinicians discussing a difficult problem. This is THE manual for the authoritative management of surgical infections!