3-4 Post-Operative Infection I and II 2024.pdf

Post-Operative Infection I & II Allen J Kempf, DPM, MS, AACFAS, DABPM Assistant Professor College of Podiatric Medicine and Surgery Des Moines University Objectives Identify patterns of soft tissue and bone infections in the foot and ankle Demonstrate knowledge of SIRS criteria and sepsis associated...

Post-Operative Infection I & II Allen J Kempf, DPM, MS, AACFAS, DABPM Assistant Professor College of Podiatric Medicine and Surgery Des Moines University Objectives Identify patterns of soft tissue and bone infections in the foot and ankle Demonstrate knowledge of SIRS criteria and sepsis associated with lower extremity infections Identify the types of foot and ankle soft tissue, joint and bone infections requiring surgery Demonstrate knowledge of the surgical techniques and goals for foot and ankle soft tissue, joint and bone infections Demonstrate knowledge of the diagnosis and surgical management of diabetic foot infections Outline Define clinical parameters of common lower extremity infections Soft tissue Bone Joint SIRS criteria Sepsis criteria Medical and surgical management of common infections Workup Treatment Expected Outcomes Infection Defined “Infection can be defined as the pathological presence of bacteria in a site or wound. This pathogenesis is evidenced by the body’s response through the presence of inflammation and white blood cells.” -Warren Joseph, DPM Handbook of Lower Extremity Infections, 3rd Edition Soft Tissue Infection- Cellulitis A bacterial skin and soft tissue infection which occurs when the physical skin barrier, the immune system and/or the circulatory system are impaired Common symptoms: Erythema Edema Warmth Tenderness https://healthjade.net/cellulitis/ Cellulitis Recurrence is high after initial episode (22-49%) Rarely, if ever, bilateral Traumatic injuries Multiple other diseases present similarly Venous insufficiency/stasis Gout DVT Charcot neuroarthropathy https://drashchiheart.com/venous-insufficiency-understanding-venous-disease/ Cellulitis Pathogens: Streptococci and S. aureus are the most commonly identified organisms Atypical organisms may be found https://www.njmonline.nl/getpdf.php?id=1907 Cellulitis Treatment Difficulty to culture Outpatient PO antibiotics covering most likely organism (Gram +) Admission may be necessary if fail outpatient antibiotics Inpatient IV antibiotics covering most likely organism (Gram +) Passive elevation Compressive dressing after resolution of symptoms - Reduction in recurrence Abscess A localized collection of purulent material encapsulated by inflammation and granulation in response to an infectious source Most commonly associated with S. aureus or streptococcal species Occur frequently in areas of skin with increased friction or minor trauma https://podiatry.com/ezine/iframe/1197 Abscess Clinical symptoms: Erythema Warmth Edema Pain Concentrated area of fluctuance Diagnosis: Clinical exam Ultrasound X-ray CT MRI Abscess Treatment Small abscess ( 50,000 and 50% neutrophils predominance Crystal analysis Culture and sensitivity Identification of organism in synovial fluid confirms diagnosis https://www.orthobullets.com/trauma/1058/septic-arthritis--adult Septic Arthritis Risk Factors Advanced age Recent joint surgery or injection Pre-existing erosive joint disease Skin or soft tissue infection IV drug abuse Long-term indwelling catheters Immunocompromised patients Septic Arthritis Treatment: IDSA Guidelines Septic Arthritis Treatment Joint drainage Arthrotomy Arthroscopy Incision and Drainage Daily needle aspiration Empiric antibiotic administration (after joint aspiration) Removal of prosthetic joint if present Based on IDSA guidelines SIRS and Sepsis Systemic Inflammatory Response Syndrome (SIRS) Clinical syndrome characterized as dysregulated response to inflammation Not only caused by infectious organism Burns, surgery, pancreatitis, autoimmune disorders SIRS Criteria Need 2 or more for confirmation: Fever > 38.0° C or < 36 ° C Tachycardia > 90 beats/min Tachypnea > 20 breaths/min Leukocytosis > 12,000 or leukopenia < 4,000 PIMP Question Sepsis Life-threatening organ dysfunction caused by dysregulated host response to infection Can result in single or multi-organ failure Prior to 2000, mortality was 50% in severe sepsis patients Mortality between 20-25% currently 1 in 3 patients who die in the hospital results from sepsis SIRS plus source of infection Sepsis Multiple objective means to diagnose National Early Warning System (NEWS) sepsis: Respiratory rate Sequential (sepsis-related) Organ Oxygen saturation Failure Assessment Score (qSOFA) Respirator rate ≥22/min Altered mental status Systolic BP