Management Of Postoperative Infections Research Articles

Management of postoperative infections in obstetrics and gynecology.

A discussion of postoperative infections in obstetrics and gynecology has been presented with particular emphasis on soft tissue infections involving the operative site. It has been emphasized that the offending organisms are those normally found in the vagina and cervix and that mixed infections are common. The immediate life threats to the patient are endotoxin shock and clostridial sepsis; therefore, initial therapy should include coverage for those organisms. Because of the potential toxicity of clindamycin and chloramphenicol, as well as the usual protracted course of Bacteroides infections, the addition of one of these drugs can generally be deferred until its use is dictated by microbiologic data or a failure of clinical response. Persistent fever generally indicates a lack of the appropriate antibiotic, an undrained collection of pus, or concomitant pelvic thrombophlebitis, the latter being a special concern with anaerobic infections. Specific infections and their management have also been discussed as have urinary tract and pulmonary infections and drug fever.

The management of postoperative infection ∗

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.