Advertisement

Wound Infections

  • Gregory John FulchieroJr.
  • Elizabeth M. Billingsley

Abstract

Wound infections are uncommon in dermatologic surgery with an overall reported incidence of 2%.1 By definition, surgical wound infections occur within 30 days of the time of the procedure and may involve the skin, subcutaneous fat, or the muscle above the fascia. The Centers for Disease Control and Prevention (CDC) has categorized skin and subcuticular surgical site infections as superficial, while those involving the muscle are categorized as deep surgical site infections.2 Most wound infections are thought to begin at the time of surgery whenever aseptic technique is broken, or bacteria are introduced into the wound due to inadequate preoperative cleansing or the use of contaminated instruments and suture material. However, infections may also be caused by patient-specific factors such as preoperative skin or nasal bacterial colonization and poor wound hygiene postoperatively.

Keywords

Wound Infection Necrotizing Fasciitis Hidradenitis Suppurativa National Nosocomial Infection Surveillance Infect Control Hosp 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Futoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg 1995;21:509–514.CrossRefPubMedGoogle Scholar
  2. 2.
    Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefPubMedGoogle Scholar
  3. 3.
    Krizek TJ, Robson MC. Evolution of quantitative bacteriology in wound management. Am J Surg 1975;130:579–584.CrossRefPubMedGoogle Scholar
  4. 4.
    Barker JNWN, Mitra RS, Griffiths CEM, et al. Keratinocytes as initiators of inflammation. Lancet 1991;337:211–214.CrossRefPubMedGoogle Scholar
  5. 5.
    Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.PubMedGoogle Scholar
  6. 6.
    Culver DH, Horan TC, Gaynes RP. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;16:91(3B):152S–157S.CrossRefGoogle Scholar
  7. 7.
    Antimicrobial prophylaxis and treatment in patients with granulocyopenia. Med Lett Drugs Ther 1981;23:55–56.Google Scholar
  8. 8.
    Perner A, Nielsen SE, Rask-Madsen J. High glucose impairs superoxide production from isolated blood neutrophils. Intensive Care Med 2003;29:642–645.PubMedGoogle Scholar
  9. 9.
    Haas AF, Grekin RC. Antibiotic prophylaxis in dermatologic surgery. J Am Acad Dermatol 1995;32:155–179.CrossRefPubMedGoogle Scholar
  10. 10.
    Jones S, Schechter CB, Smith C, et al. Is HIV infection a risk factor for complications of surgery? Mt Sinai J Med 2002;69:329–333.PubMedGoogle Scholar
  11. 11.
    Patton LL, Shugars DA, Bonito AJ. A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures. J Am Dent Assoc 2002;133:195–203.PubMedGoogle Scholar
  12. 12.
    Burns J, Pieper B. HIV/AIDS: impact on healing. Ostomy Wound Manage 2000;46:30–40.PubMedGoogle Scholar
  13. 13.
    Seropian R, Reynolds BR. Wound infections after preoperative depilatory versus razor preparation. Am J Surg 1971;121:251–254.CrossRefPubMedGoogle Scholar
  14. 14.
    Miro D, Julia MV, Sitges-Serra A. Wound breaking strength and healing after suturing noninjured tissues. J Am Coll Surg 1995;180:659–665.PubMedGoogle Scholar
  15. 15.
    Coras B, Hohenleutner U, Landthaler M, et al. Comparison of two absorbable monofilament polydioxanone threads in intradermal buried sutures. Dermatol Surg 2005;31:331–333.PubMedGoogle Scholar
  16. 16.
    NNIS System: National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986–April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996;24:380–388.CrossRefGoogle Scholar
  17. 17.
    Davies RR. Dispersal of bacteria on desquamated skin. Lancet 1962;2:1295–1297.CrossRefPubMedGoogle Scholar
  18. 18.
    Ong PY, Ohtake T, Brandt C, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med 2002;347:1151–1160.CrossRefPubMedGoogle Scholar
  19. 19.
    Bayer AS. Infective endocarditis. Clin Infect Dis 1993;17:313–320.PubMedGoogle Scholar
  20. 20.
    Eady EA, Coates P, Ross JI, et al. Antibiotic resistance patterns of aerobic coryneforms and furazolidone-resistant Gram-positive cocci from the skin surface of the human axilla and fourth toe cleft. J Antimicrob Chemother 2000;46:205–213.CrossRefPubMedGoogle Scholar
  21. 21.
    Cunha BA, Koj IG. Serratia marscens: nosocomial implications. Infect Dis Pract 1999;23:49–52.Google Scholar
  22. 22.
    Podschun R, Ullmann U. Klebsiella species as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998;11:589–603.PubMedGoogle Scholar
  23. 23.
    Robson MC. A failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am 1997;77:637–651.CrossRefPubMedGoogle Scholar
  24. 24.
    Robson MC, Lea CE, Dalton JB, et al. Quantitative bacteriology and delayed wound closure. Surg Forum 1968;19:501–502.PubMedGoogle Scholar
  25. 25.
    Levine NS, Lindberg RB, Mason AD, et al. The quantitative swab culture and smear: a quick simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma 1976;16:89–94.CrossRefPubMedGoogle Scholar
  26. 26.
    Ford DA, Koehler SH. A creative process for reinforcing aseptic technique practices. AORN J 2001;73:446–450.CrossRefPubMedGoogle Scholar
  27. 27.
    Seal LA, Paul-Cheadle D. A systems approach to preoperative surgical patient skin preparation. Am J Infect Control 2004;32:57–62.CrossRefPubMedGoogle Scholar
  28. 28.
    Bencini PL, Galimberti M, Signorini M. Utility of topical benzoyl peroxide for prevention of surgical skin wound infections. J Dermatol Surg Oncol 1994;20:538–540.PubMedGoogle Scholar
  29. 29.
    Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 2004:CD003949.Google Scholar
  30. 30.
    Berry A, Watt B, Goldacre M, Thomson J, McNair T. A comparison of the use of povidone-iodine and chlorhexidine in the prophylaxis. J Hosp Infect 1982;3:55–63.CrossRefPubMedGoogle Scholar
  31. 31.
    Aly R, Maibach HI. Comparative antibacterial efficacy of a 2-minute surgical scrub with chlorhexidine gluconate, povidone-iodine, and chloroxylenol sponge-brushes. Am J Infect Control 1988;16:173–177.CrossRefPubMedGoogle Scholar
  32. 32.
    Hibbard JS, Mulberry GK, Brady AR. A clinical study comparing the skin antisepsis and safety of ChloraPrep, 70% isopropyl alcohol, and 2% aqueous chlorhexidine. J Infus Nurs 2002;25:244–249.CrossRefPubMedGoogle Scholar
  33. 33.
    Shirahatti RG, Joshi RM, Vishwanath YK. Effect of preoperative skin preparation on post-operative wound infections. J Postgrad Med 1993;39:134–136.PubMedGoogle Scholar
  34. 34.
    Glabman M. The top tem malpractice claims [and how to avoid them]. Hosp Health Netw 2004;78:60–66.PubMedGoogle Scholar
  35. 35.
    Jevons PM. “Celbenin”-resistant staphylococci. Br Med J 1961;124–125.Google Scholar
  36. 36.
    Kuehnert MJ, Hill HA, Kupronis BA, et al. Methicillinresistant-Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11:868–872.PubMedGoogle Scholar
  37. 37.
    Valencia IC, Kirsner RS, Kerdel FA. Microbiologic evaluation of skin wounds: alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period. J Am Acad Dermatol 2004;50:845–849.CrossRefPubMedGoogle Scholar
  38. 38.
    Naimi TS, LeDell KH, Como-Sabietti K, et al. Comparison of community-and health care-associated methicillinresistant Staphylococcus aureus infection. JAMA 2003;290:2976–2984.CrossRefPubMedGoogle Scholar
  39. 39.
    Cohen PR, Kurzrock R. Community-acquired methicillinresistant Staphylococcus aureus skin infection: an emerging clinical problem. J Am Acad Dermatol 2004;50:277–280.CrossRefPubMedGoogle Scholar
  40. 40.
    Iyer S, Jones DH. Community-acquired methicillin-resistant Staphylococcus aureus skin infection: a retrospective analysis of clinical presentation and treatment of a local outbreak. J Am Acad Dermatol 2004;50:854–858.CrossRefPubMedGoogle Scholar
  41. 41.
    Tacconelli E, D’Agata EM, Karchmer AW. Epidemiological comparison of true methicillin-resistant and methicillinsusceptible coagulase-negative bacteremia at hospital admission. Clin Infect Dis 2003;37:644–649.CrossRefPubMedGoogle Scholar
  42. 42.
    Quintiliani R, Kuti J. Drug therapy for methicillin-resistant Staphylococcus aureus. Conn Med 2001;65:23–25.PubMedGoogle Scholar
  43. 43.
    Jones RS. Expert advice on eradicating the MRSA threat. Pract Dermatol 2005;2:33–37.Google Scholar
  44. 44.
    Cohen PA, Grossman ME. Management of cutaneous lesions associated with an emerging epidemic: communityacquired methicillin-resistant Staphylococcus aureus skin infections. J Am Acad Dermatol 2004;51:132–135.CrossRefPubMedGoogle Scholar
  45. 45.
    Anderegg TR, Sader HS, Fritsche TR, et al. Trends in linezolid susceptibility patterns: report from the 2002–2003 worldwide Zyvox Annual Appraisal of Potency and Spectrum (ZAAPS) Program. Int J Antimicrob Agents 2005;26:13–21.CrossRefPubMedGoogle Scholar
  46. 46.
    Guilhermetti M, Hernandes ED, Fukushigue Y, et al. Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. Infect Control Hosp Epidemiol 2001;22:105–108.CrossRefPubMedGoogle Scholar
  47. 47.
    Semret M, Miller MA. Topical mupirocin for eradication of MRSA colonization with mupirocin-resistant strains strains. Infect Control Hosp Epidemiol 2001;22:578–580.CrossRefPubMedGoogle Scholar
  48. 48.
    Boyce JM. MRSA patients: proven methods to treat colonization and infection. J Hosp Infect 2001;48(Suppl A):S9–S14.CrossRefPubMedGoogle Scholar
  49. 49.
    Kline S, Cameron S, Streifel A. An outbreak of bacteremias associated with Mycobacterium mucogenicum in a hospital water supply. Infect Control Hosp Epidemiol 2004;25:1042–1049.CrossRefPubMedGoogle Scholar
  50. 50.
    Mycobacterium chelonae infections associated with face lifts — New Jersey, 2002–2003. MMWR 2004;53:192–194.Google Scholar
  51. 51.
    Safranek TJ, Jarvis WR, Carson LA, et al. Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skin-marking solution. N Engl J Med 1987;317:197–201.PubMedCrossRefGoogle Scholar
  52. 52.
    Brickman M, Parsa AA, Parsa FD. Mycobacterium chelonae infection after breast augmentation. Aesthetic Plast Surg 2005;29:116–118.CrossRefPubMedGoogle Scholar
  53. 53.
    Meyers H, Brown-Elliot BA, Moore D, et al. An outbreak of Mycobacterium chelonae infection following liposuction. Clin Infect Dis 2002;34:1500–1507.CrossRefPubMedGoogle Scholar
  54. 54.
    Murillo J, Torres J, Bofill L, et al. Skin and wound infection by rapidly growing mycobacteria: an unexpected complication of liposuction and liposculpture. The Venezuelan Collaborative Infectious and Tropical Diseases Study Group. Arch Dermatol 2000;136:1347–1352.CrossRefPubMedGoogle Scholar
  55. 55.
    Prado AC, Castillo PF. Lay clinics and an epidemic outbreak of mycobacterium skin and soft-tissue infection. Plast Reconstr Surg 2004;113:800–801.CrossRefPubMedGoogle Scholar
  56. 56.
    Wallace RJ Jr, Brown BA, Onyi GO. Skin, soft tissue, and bone infections due to Mycobacterium chelonae chelonae: importance of prior corticosteroid therapy, frequency of disseminated infections, and resistance to oral antimicrobials other than clarithromycin. J Infect Dis 1992;166:405–412.PubMedGoogle Scholar
  57. 57.
    Madjar DD Jr, Carvallo E, Proper SA, et al. Adjunctive surgical management of cutaneous Mycobacterium fortuitum infection. J Dermatol Surg Oncol 1985;11:708–712.PubMedGoogle Scholar
  58. 58.
    Saluja A, Peters NT, Lowe L, et al. A surgical wound infection due to Mycobacterium chelonae successfully treated with clarithromycin. Dermatol Surg 1997;23:539–543.CrossRefPubMedGoogle Scholar
  59. 59.
    Gutknecht DR. Treatment of disseminated Mycobacterium chelonae infection with ciprofloxacin. J Am Acad Dermatol 1990;23:1179–1180.CrossRefPubMedGoogle Scholar
  60. 60.
    Kullavanijaya P, Rattana-Apiromyakij N, Sukonthapirom-Napattalung P, et al. Disseminated Mycobacterium chelonae cutaneous infection: recalcitrant to combined antibiotic therapy. J Dermatol 2003;30:485–491.PubMedGoogle Scholar
  61. 61.
    Segal E. Candida, still number one — what do we know and where are we going from there? Mycoses 2005;48(Suppl 1):3–11.CrossRefPubMedGoogle Scholar
  62. 62.
    Garman ME, Orengo I. Unusual infectious complications of dermatologic procedures. Dermatol Clin 2003;21:321–335.PubMedGoogle Scholar
  63. 63.
    Hughes MG, Chong TW, Smith RL, et al. Comparison of fungal and nonfungal infections in a broad-based surgical patient population. Surg Infect 2005;6:55–64.CrossRefGoogle Scholar
  64. 64.
    Bille J, Marchetii O, Calandra T. Changing face of healthcare associated fungal infections. Curr Opin Infect Dis 2005;18:314–319.CrossRefPubMedGoogle Scholar
  65. 65.
    Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24:315–320.CrossRefPubMedGoogle Scholar
  66. 66.
    da Silva LM, Guimaraes AL, Victoria JM, et al. Herpes simplex virus type 1 shedding in the oral cavity of seropositive patients. Oral Dis 2005;11:13–16.CrossRefPubMedGoogle Scholar
  67. 67.
    Beeson WH, Rachel JD. Valacyclovir prophylaxis for herpes simplex virus infection or infection recurrence following laser skin resurfacing. Dermatol Surg 2002;28:331–336.CrossRefPubMedGoogle Scholar
  68. 68.
    Alster TS, Nanni CA. Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing. Dermatol Surg 1999;25:242–246.CrossRefPubMedGoogle Scholar
  69. 69.
    Hsiao GH, Chang CH, Hsiao CW, et al. Necrotizing soft tissue infections. Surgical or conservative treatment? Dermatol Surg 1998;24:243–247.CrossRefPubMedGoogle Scholar
  70. 70.
    Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillinresistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352:1445–1453.CrossRefPubMedGoogle Scholar
  71. 71.
    Feingold DS. Gangrenous and crepitant cellulitis. J Am Acad Dermatol 1982;6:289–299.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Gregory John FulchieroJr.
    • 1
  • Elizabeth M. Billingsley
    • 2
  1. 1.Department of DermatologyUniversity of TexasSouthwestern, DallasUSA
  2. 2.Department of DermatologyPenn State University College of Medicine, Hershey Medical CenterHersheyUSA

Personalised recommendations