Abstract
The incidence of postoperative infections decreased after 1941 and reached a low level until 1954. The incidence then began to increase and approach that of the preantimicrobic era. Many factors besides the use and misuse of antimicrobics are responsible. The incidence probably cannot be reduced greatly because of the hazards of operations now performed in vital areas, and the extensive use of antimicrobic agents, corticosteroids and other powerful agents. Improvement can be attained by careful preoperative, operative and postoperative management. Clyses, aspirations, intubations, transfusions, binders, drugs, sedatives and tracheotomy should be applied with restraint and only when necessary. Routine prophylaxis with antimicrobic agents is condemned, but the drugs are effective in instances wherein specific agents can be applied against sensitive microbes. The failure of treatment of the increasing number of infections caused by resistant bacteria, previously of little importance, provides a problem to be solved. Antimicrobic therapy even when appropriate may fail when the natural mechanism of defense against infection is impaired. Enhancement of resistance is equal in importance to drug therapy.
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