From the Guidelines
Superficial surgical site infections can often be managed by opening the incision without antibiotics, as this approach allows for drainage of purulent material and promotes healing through secondary intention 1. This method is typically sufficient for uncomplicated superficial infections where the infection is limited to the skin and subcutaneous tissue without deeper involvement. After opening the incision, regular wound care with gentle cleansing and dressing changes should be performed.
Some key points to consider in the management of superficial surgical site infections include:
- The primary therapy for these infections is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention 1.
- Antibiotics may be necessary in certain situations, such as if the patient has systemic symptoms (fever, elevated white blood cell count), significant surrounding cellulitis, immunocompromise, or if the infection involves prosthetic material or occurs in a high-risk area 1.
- When antibiotics are needed, empiric therapy should target common skin flora like Staphylococcus aureus and streptococci, with options including cephalexin or dicloxacillin for 5-7 days 1.
- The rationale for avoiding unnecessary antibiotics includes preventing antimicrobial resistance, reducing side effects, and recognizing that adequate drainage is often the most important intervention for localized collections of pus 1.
It's also important to note that the management of superficial surgical site infections should be individualized based on the patient's specific condition and the presence of any underlying risk factors, such as diabetes, obesity, or immunocompromise 1. By taking a thoughtful and evidence-based approach to the management of these infections, clinicians can help to optimize patient outcomes and reduce the risk of complications.
From the Research
Treatment of Superficial Surgical Site Infections
- The treatment of superficial surgical site infections (SSIs) can involve opening the incision, but it may also require antibiotic therapy, depending on the severity of the infection and the presence of any underlying conditions 2, 3.
- The primary treatment for SSIs encompasses liberal debridement of the wound, which may include opening the incision to allow for drainage and cleaning of the affected area 2.
- Antibiotic therapy is often used in conjunction with wound debridement to treat SSIs, and the choice of antibiotic will depend on the type of bacteria present and the severity of the infection 3, 4.
- In some cases, new antibiotics such as avibactam and dalbavancin may be used to treat SSIs, particularly if standard antibiotics are not effective or if the patient has a history of antibiotic resistance 3.
Factors Influencing Treatment
- The management of SSIs depends on various factors, including the type of procedure performed, the location and nature of the infection, and the presence of any underlying conditions such as diabetes or immunosuppression 2, 5.
- Early detection and treatment of SSIs are critical to preventing complications and reducing the risk of antibiotic resistance 3, 5.
- The use of antibiotic prophylaxis and antisepsis of the surgical area can help prevent SSIs, and intraoperative subcutaneous wound irrigation with an antiseptic solution may also reduce the risk of infection 2.
Consensus on SSI Management
- A consensus among experts from five European countries found that resistant pathogens are an increasing concern in SSI management, and that early discharge programs and new treatment alternatives are crucial to reducing harm to patients and costs for hospitals 5.
- The consensus also highlighted the importance of interdisciplinary teamwork and the need for established protocols for the treatment of SSIs, including the use of antibiotics that allow for early discharge 5.