Ιστορική αναδρομή
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Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών, Γενικό Πανεπιστημιακό Νοσοκομείο ‘Αττικόν’, Δ’ Χειρουργική Κλινική Λ οίμωξη του Χειρουργικού Τραύματος Ι. Ν. Παπαδόπουλος FRCS, Επ. Καθηγητής. Ιστορική αναδρομή. - PowerPoint PPT Presentation
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M 19 - 20 Pasteur, Lister, Koch, Metchnikoff Erlich 1940 1970 : *Fildes J. Surg Clin North Am 1991*Meakins JL. World J Surg 1998.
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Robson MC. Surg Clin North Am 1997
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/ (CDC) , , , ( ) , : , , (, , ): ,
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. 1986-1992. 52.388 / 42.509 37% 24% / 13%27% 15% 7% 15% ~100%*Horan TC, et al. Infect Control Hosp Epidemiol 1993; 14:73-80.
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, .. .
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.. , , .
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( ), .
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( , , ...) .
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: .
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(Systemic Inflammatory Response Syndrome, SIRS), (sepsis) (severe sepsis), shock (septic shock), (MODS).
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3 1) . o , (, inoculum), , 2) . (environment): (local defenses) 3) (host defense mechanisms) (the immune system)
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DETERMINANTS OF ANY INFECTIOUS PROCESS: INTERSECTION POINT: ZERO PROBABILITY. (Meakins JL)BACTERIAHOST DEFENSE MECHANISMSSURGICAL SITE
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BACTERIA
Dose / InoculumVirulenceResistance
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: 100.000 , *Robson MC. Surg Clin North Am 1997
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I: (clean) .. II: (clean contaminated) .. , .III: (contaminated), .. IV: ( ) , (dirty and infected), .. .
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SURGICAL SITE INFECTION RATES
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Pathogens Isolated. N = 17.671. NNIS 1990-1996
Staphylococcus aureus20 %Coagulase - negative staphylococci14 %Enterococcus spp. 12 %Escherichia coli8 %Pseudomonas aeroginosa8 %Enterobacter spp. 7 %Proteus mirabilis3 %Clebsiella pneumoniae3 %Candida albicans3 %Bacteroides fragilis2 %Others20 %
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Staph. aureus, coagulase () staph. Staph. aureus, coagulase () staph Staph. aureus, coagulase () staphStaph. aureus, coagulase () staph, streptococci, gram (-) bacilliStaph. aureus, coagulase () staph. Gram (-) bacilli / Staph. aureus, coagulase () staph, strept. pneumoniae, gram (-) bacilliStaph. aureus, coagulase () staph. Gram (-) bacilli, anaerobesGram () bacilli, anaerobes Gram () bacilli, anaerobes / Gram () bacilli, streptococci, oropharyngeal anaerobes (peptostreptococci) / ( ) Staph. aureus, streptococci, oropharyngeal anaerobes (peptostreptococci) / Gram () bacilli, enterococci, group B streptococci, anaerobes Gram () bacilli ? Anonymous. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 1977;39:97-102.
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- - (>3 ) Cruse PJE. Surg Clin North Am 1980
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Hand washing and disinfectionIs the Single Most Important Preventive factor of Wound Infection
*Reybrouck G. Handwashing and disinfection. Journal of Hospital Infection 1986;8:5-23
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: . .. , , . .. . *Edwards LD. Ann Surg 1976
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,
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(clean). . , , ,
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*Polk HC et al. Surgery 1969; 66: 97-103.
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( IV, dirty and infected) . ( II, clean contaminated) ( III, contaminated) , .
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, ( I, clean) : 1) 2) ,3) .. , , ,
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. ( , ) .
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. 3 , .
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Timing of Antibiotic Prophylaxis / SSI Rate Classen DC. 1992
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30 min 1 . 24 , . *Classen DC, et al. N Engl J Med 1992
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Staph. Ayureus.
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1) / 2) ( ), 18-26 C 50 - 60%.
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, , , , : , , (HIV).
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* K 3 -5 min A: povidone- iodine chlorexidine *Cruse PJE et al. Surg Clin North Am 1980
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.
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* (>2 ) (). *Haley RW et al. Am J Epidemiol 1985
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(Systemic host defenses mechanisms)
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(humoral immunity, ), - (cell-mediated), - .
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. .
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/ Immunoenhancement;
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. K (Shock)
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4 8 .
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Intrinsic Susceptibility to InfectionThere is a need to stratify patients and not only the wound Condon RE. Arch Surg 1988; 123: 250-256
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(clean) < 1% = 1 - 2% = > 2% = Cruse PJE, Foord R. Surg Clin North Am 1980; 60: 27-40
