Surgical procedures inherently carry the risk of infection. From superficial skin abscesses to life-threatening gas gangrene and post-operative sepsis, understanding the various types of surgical infections is critical for prevention, early recognition, and effective treatment. This in-depth guide covers specific surgical infections like cellulitis, tetanus, and gas gangrene, alongside a detailed protocol for managing post-operative pyrexia.
Introduction
Post-operative complications can often be subtle at first—but among the most dangerous are specific surgical infections and pyrexia (fever) following surgery. Whether it’s a staphylococcal furuncle or Clostridium-induced gas gangrene, rapid identification and targeted treatment save lives. Let’s explore how to recognize, manage, and prevent these threats in surgical care.
Types of Specific Surgical Infections
1. Cellulitis
- Cause: Streptococcus pyogenes
- Common variant: Erysipelas
- Anaerobic cellulitis: Caused by mixed bacteria like Bacteroides
- Serious form: Necrotizing fasciitis or Fournier’s gangrene
- Treatment:
- Resuscitation
- Broad-spectrum antibiotics (e.g., penicillin, metronidazole, gentamicin)
- Wide surgical debridement
2. Staphylococcal Infections
Organisms: Staphylococcus aureus, Staph. epidermidis
Variants:
- Furuncle: Hair follicle abscess
- Stye: Eyelash follicle infection
- Carbuncle: Network of infected follicles
- Sycosis barbae: Beard area infection from shaving
- Hidradenitis suppurativa: Chronic apocrine gland infection (axilla, groin)
3. Gas Gangrene
Organisms: Clostridium perfringens, C. novyi, C. septicum
Risk Factors: Soil contamination of necrotic wounds
Symptoms:
- Muscle crepitus
- Foul discharge
- Rapid tissue necrosis
- Emergency resuscitation
- Multiple surgical debridements
- Antibiotics (penicillin + clindamycin)
4. Tetanus
Cause: Clostridium tetaniSymptoms:
- Trismus (lockjaw)
- Muscle rigidity and spasms
- Autonomic instability
Prevention:
- Tetanus toxoid vaccine at birth, 5 years, and school booster
- Immunoglobulin for contaminated wounds
- Supportive care
- Sedation and muscle relaxants
- Antibiotics (metronidazole preferred)
Post-Operative Infections
Pyrexia After Surgery – A Diagnostic Challenge
Fever is often the first sign of surgical infection. While a mild rise may be expected post-op (especially within 24 hours due to atelectasis), persistent or delayed fever indicates deeper problems like abscesses, thrombosis, or sepsis.
Early Workup: The Septic Screen
When fever appears post-surgery:
Investigations:
- Urine, sputum, blood cultures
- Wound swab
- Imaging: Chest X-ray, Ultrasound, CT scan (especially in abdominal cases)
Sites to Check:
- Lungs (atelectasis or pneumonia)
- Surgical wounds
- Calves (for DVT)
- Urine (UTI)
- IV and central lines
Management:
- Antibiotics targeting the ‘most likely organism’
- Drain pus or remove infected lines/catheters
- Respiratory support (physiotherapy if chest infection suspected)
Common Causes of Post-Operative Pyrexia
1. Intra-abdominal Infections
Organisms: E. coli, Klebsiella, Proteus, Strep. faecalis, Bacteroides
Symptoms: Generalized peritonitis, abdominal pain, rigidity, loss of bowel sounds- Emergency laparotomy
- Broad-spectrum IV antibiotics
- Source control (e.g., drain abscess)
2. Intra-abdominal Abscess
Features: Fever, localized tenderness, sepsis- Surgical or radiological drainage
- Targeted antibiotics
3. Respiratory Infections
Causes: Pre-existing lung disease, smoking, starvation, post-op painPrevention:
- Incentive spirometry
- Chest physiotherapy
- Stop smoking pre-op
- Antibiotics and analgesia
- Encourage deep breathing
4. Urinary Tract Infections
Risk Factor: Urinary catheter- Catheterize only when needed
- Use sterile technique
- Antibiotics guided by culture
- Ensure adequate hydration
5. Central Line Infections
Risk Factor: Parenteral nutrition via central linesPrevention:
- Sterile insertion
- Line care
- Remove line if possible
- Antibiotics based on culture
6. Pseudomembranous Enterocolitis
Cause: Clostridium difficile
Trigger: Prolonged antibiotic use- Oral vancomycin or metronidazole
- Stop causative antibiotics
- Surgery rarely needed
Tackling Multidrug-Resistant Organisms (MDRO)
Examples:
- MRSA (Methicillin-resistant Staph. aureus)
- VRE (Vancomycin-resistant Enterococcus)
- ESBL-producing E. coli, Klebsiella
Prevention Strategies:
- Hand hygiene
- Isolation protocols
- Targeted antibiotic usage
- Environmental disinfection
- Screening of high-risk patients
Summary of Essential Practices
| Action | Rationale |
|---|---|
| Septic screen in febrile patients | Early detection of systemic infection |
| Drainage of abscesses | Prevent systemic spread and sepsis |
| Antibiotics based on cultures | Prevent resistance, ensure efficacy |
| Pre-op tetanus prophylaxis | Prevent life-threatening complications |
| Monitor for respiratory distress | Prevent pneumonia post-op |
| Manage catheter and IV lines | Prevent bloodstream infections |
Frequently Asked Questions (FAQs)
Q1. When should you suspect post-op infection?
A: Any new onset of fever, especially after 48–72 hours, or wound changes like pus, swelling, or pain.
Q2. What’s the gold standard for managing abscesses?
A: Prompt surgical or radiological drainage followed by targeted antibiotics.
Q3. What causes gas gangrene in surgical patients?
A: Clostridium species infecting devitalized tissues, especially post-trauma or dirty surgery.
Q4. How to prevent MDRO spread in hospitals?
A: Isolate infected patients, use gloves/masks, and limit unnecessary antibiotic use.
Q5. Can you give antibiotics before confirming infection?
A: Yes, empirically based on the most likely pathogen, but always refine after culture results.
