From the Guidelines
Superficial surgical site infections (SSIs) should be treated by opening the wound, draining any purulent material, and performing daily wound care with saline irrigation and packing until the wound heals by secondary intention, with antibiotics generally not recommended for uncomplicated cases, but considered for 5-7 days in cases with systemic inflammatory response or signs of organ failure, with choices including cephalexin, dicloxacillin, or clindamycin, and wound cultures obtained before starting antibiotics to guide therapy if the infection doesn't improve 1.
Key Considerations
- Superficial SSIs involve only the skin and subcutaneous tissue of the incision, and treatment should focus on local infection control through drainage and wound care.
- Antibiotics are not necessary for uncomplicated superficial SSIs, but may be considered in cases with systemic inflammatory response or signs of organ failure.
- Wound cultures should be obtained before starting antibiotics to guide therapy if the infection doesn't improve.
- Patients should keep the wound clean, change dressings as directed, monitor for spreading redness, increasing pain, fever, or purulent drainage, and follow up within 48-72 hours to assess response to treatment.
Management Approach
- Open the wound and drain any purulent material to control the local infection.
- Perform daily wound care with saline irrigation and packing to promote healing.
- Consider antibiotics for 5-7 days in cases with systemic inflammatory response or signs of organ failure, with choices including cephalexin, dicloxacillin, or clindamycin.
- Obtain wound cultures before starting antibiotics to guide therapy if the infection doesn't improve.
Evidence-Based Recommendations
- The 2018 WSES/SIS-E consensus conference recommends that superficial incisional SSIs be managed by opening the wound, draining any purulent material, and performing daily wound care with saline irrigation and packing until the wound heals by secondary intention, with antibiotics generally not recommended for uncomplicated cases 1.
- The conference also recommends that empiric broad-spectrum antibiotic treatment be initiated in patients with incisional SSIs with the presence of any systemic inflammatory response criteria or signs of organ failure 1.
- A study published in the World Journal of Emergency Surgery in 2018 found that superficial SSIs can be effectively managed with local infection control measures, and that antibiotics may not be necessary in uncomplicated cases 1.
From the Research
Definition and Classification of Superficial SSI
- Superficial surgical site infections (SSIs) are typically defined as infections that occur within 30 days of a surgical procedure and involve only the skin and subcutaneous tissue 2.
- These infections can be caused by a variety of bacteria, including Staphylococcus aureus, which is a common cause of skin and soft tissue infections [(3,4)].
Risk Factors and Prevention
- Risk factors for developing superficial SSI include wound contamination, poor wound care, and the use of inappropriate antimicrobial prophylaxis 2.
- Preventive measures, such as improved adherence to evidence-based preventive measures related to appropriate antimicrobial prophylaxis, can decrease the risk of SSI 2.
Treatment and Management
- Treatment of superficial SSI typically involves aggressive surgical debridement and effective antimicrobial therapy 2.
- The choice of antimicrobial agent depends on the suspected or confirmed causative organism, with options including penicillinase-resistant penicillins, cephalosporins, clindamycin, and vancomycin [(3,4)].
- New antibiotics, such as avibactam and dalbavancin, may also be used in the treatment of SSI, although their use should be guided by susceptibility testing and reserved for cases where standard treatments are inappropriate 5.
Guidelines and Recommendations
- The Surgical Infection Society has published updated guidelines on the management of complicated skin and soft tissue infections, which include recommendations for antimicrobial therapy and duration of treatment 6.
- These guidelines emphasize the importance of adjuvant antimicrobial therapy after drainage of complex abscesses and provide support for the use of alternative antimicrobial agents 6.