Infections are the result of invasion into the body of pathogens and the reaction of body tissues to these pathogens and their toxins. Only a small part of the many thousands of microorganisms existing in nature and is known to the present day, are pathogenic for humans. Other microbes living in the body, constitute the normal microflora, and their existence provides a natural resistance of the organism to pathogenic strains.
Infections continue to be a significant challenge of modern surgery in the same as it was in the past. The creation of new and more powerful antibiotics entails the emergence of new strains resistant to them pathogens.
Nosocomial infections are those which are passed previously infected patient due to hospital acquired infection. Such hospital-acquired infections can be caused particularly by the resident microorganisms as they exist in hospital acquired environment applications of broad-spectrum antibiotics. Among hospital-acquired staphylococcal infections remains one of the most frequent.
About autoinfection say in those cases when the agent becomes the germ pre-existing in the organism as a saprophyte. Alternative autoinfection is secondary iatrogenic infection related to, for example, with manipulation of a doctor or nurse, as the installation of bladder or winsniffer.
Particularly the virulence of pathogens is determined by their ability to penetrate tissue and to cause disease. The criterion of virulence is the minimum number of microbes that can cause disease in certain individuals. Typically, such assessment is carried out in the experiment animals^ can be entirely distributed at infectious pathology in humans.
Carriers are considered the healthiest people in the body which live and reproduce certain microbes that do not cause clinical manifestations of the disease. Example of such situation is the presence in the oropharynx of representatives of hospital medical staff in antibiotic-resistant staphylococci, which can be transmitted to patients by contact with them, and cause infectious complications that is not accompanied by any painful manifestations in carriers.
Opportunistic infections are caused by opportunistic microorganisms, which only in certain conditions can be causative agents of infectious diseases (complications), normally observed in immune deficiency. To protect the body from microbes are provided with: 1) intact skin and mucous membranes, 2) a system of circulating blood cells-phagocytes, 3) antibody production, and 4) ability of the organism to respond in the form of local tissue reaction (hyperemia and leukocytosis.
The virulence and pathogenicity of bacteria is determined by their ability to produce toxins. Exotoxins are specific soluble proteins produced by a number of bacteria that can cause cyto-toxic effects in tissues remote from their place of manufacture. Examples of exotoxin-producing microbes are Clostridium tetani, and Streptococcus pyogenes. Endotoxins — lipopolysaccharide complexes that are in the membranes of gram-negative bacteria. These lipopolysaccharides, entering the bloodstream at the” destruction of bacteria that cause pronounced systemic reaction of the organism in the form of fever, tachycardia and hypotension.
Clinical signs of infection are redness, swelling tissue, raising its temperature and the feeling of pain in the area. The dysfunction of the affected organ (tissue) — one of the clinical manifestations, often noted in the occurrence of infectious foci. Other nonspecific symptoms include fever, tachycardia, and chills. Leukocytosis in the peripheral blood indicates the development in the body infection. A typical “left shift” in the leucocyte count when more than 85% of leukocytes in a smear of peripheral blood are immature granulocytes.
Exudate is an extracellular fluid, the accumulation of which in tissues or serous cavities usually indicates the development of infection. This liquid when you receive it from the cavities must be evaluated by a doctor on the subject of its color, smell and consistency — characteristics that can help roughly determine the type of microflora that caused the inflammation. In addition, the type of gram staining smear of the sediment of the exudate is important for identifying group membership of the agent and the application of directed antibiotic therapy. In some cases, useful for diagnostics may be a biopsy of the inflamed tissue. This is especially true when granulomatous inflammation associated with, for example, tuberculosis or playtomato.
Bacteriological cultivation on a nutrient medium — the next step in the diagnosis and treatment of infection. To get the desired result you need the right fence material to identify aerobic or anaerobic microflora. The cultures is the most important diagnostic technique in the fight against surgical infection. Bacteriological examination of the blood is used to diagnose infection with unspecified primary focus. Patients with clinical signs of sepsis to improve the accuracy of the study should be conducted repeatedly. When transient bacteremia, however, to identify the causative agent in the blood with the help of cultures usually fail. Chills and fever is the most common phenomenon, encouraged to conduct bacteriological examination of blood, typically are delayed for 30-90 minutes in relation to the episode of bacteremia. For this reason, the diagnosis of septicemia with unclear primary focus of infection are necessary re-randomized (random in time) blood sampling for the study.
The first principle of surgical treatment of source of infection after confirmation is the removal of necrotic masses and nonviable tissue. These tissues contain foreign particles and many microorganisms, bad krovosnabjaemah and therefore does not protect the body from pathogens. The next step should be drainage of abscesses to remove them from the pus, which is very important. In the presence of foreign particles, around which usually there are a lot of microbes, they must be removed is the third principle of surgical treatment of purulent focus. Auxiliary measures in the treatment of surgical infections are immobilization of the affected area, the creation of its elevated position to ensure a good outflow of venous blood and lymph and reduce inflammation swelling and pain. Apply a heated wet dressings to improve the local blood circulation and exudation.
The most common in surgical practice infectious diseases and complications.
Cellulitis — inflammation of subcutaneous fat, which is usually caused by hemolytic Streptococcus. Usually this inflammation is not accompanied by suppuration. The skin over the lesion, which also may be involved in the infectious process appears red, hot to the touch and compacted.
Lymphangitis — inflammation of cellulite with lymphatic vessels. Clinically manifested by the appearance on the skin of the extremities of red longitudinal stripes. The usual causative agent is the hemolytic Streptococcus. Treatment: rest, immobilization of the limb, imparting to it a high position, antibiotics.
Mug — widespread cellulitis and lymphangitis, usually with a clear demarcation line between the area of inflammation and healthy tissue. Treatment is the same as in lymphangitis.
Abscess — a circumscribed area of inflammation in the form of a cavity containing pus. Treatment in the majority of cases consists in the opening of the cavity and its drainage. Antibiotics complement surgery, but in any case not to replace it.
Impetigo is called vnutriepetelialnaya multiple small ulcers. The most common pathogens — streptococci and staphylococci.
A peculiar type of abscess is a furuncle . This abscess occurs in the hair bag and the size is usually larger than the pustules in impetigo.
Carbuncles — the result of the progression of boils with spread of the inflammation on underlying tissue. “They usually are caused by Staphylococcus aureus, however, often reveals a combination of staphylococci with gram-negative bacilli and streptococci.
Bacteremia — a condition characterized by the circulation of bacteria in the blood without signs of toxemia or any other clinical manifestations. Bacteremia is usually transient and lasts for a limited period of time. Under favorable conditions, macrophages capture and destroy infiltrated into the blood of pathogens.
Septicemia is characterized by the penetration into the bloodstream of bacteria and their toxins. Septicaemia can occur with direct contact of the pathogen in the blood, but this usually occurs secondary of the source of infection in the tissues. Mechanisms of penetration of bacteria into the bloodstream are: 1) continued erosion of the pus of the vessel wall, 2) microbial embolism, 3) mixing with blood from an infected lymph.
Toxaemia referred to the presence in blood of circulating bacterial toxins, although the microbes producing them, can the blood be absent. Toxemia is usually observed in conditions caused by toxin-producing bacteria such as Clostridium. Eating foods containing botulinum toxin or staphylococcal enterotoxin, can cause severe toxaemia in the absence of the pathogen.
Antibiotics are chemical substances that act primarily on parasitic organisms and do not act on the human body. These substances can be divided into antibiotics bacteriostatic and bactericidal action. Bacterio-static antibiotics prevent bacteria but do not kill them; bactericidal antibiotics are actively destroying microorganisms.