Systemic factors (e.g., extremes of age, poor nutrition, or diabetes) contribute to wound infections; however, local factors (e.g., necrotic tissue, poor perfusion, foreign bodies, and hematomas) are of greatest significance. In nontraumatic, uninfected operative wounds in which the respiratory, alimentary, and genitourinary tract were not entered, infection rates are low. In these cases, the infecting organism is usually from the skin but can originate from remote infected sources (e.g., urinary tract infection). If there is a remote infected source, the organism is probably the same in both infections. Wounds associated with entering the respiratory, alimentary, or genitourinary tract or secondary to trauma have a higher risk of infection.
Presenting signs and symptoms of wound infections include increasing pain, erythema, swelling, drainage, and tenderness at the incision site. Wounds not inolving the perineum and not associated with entry into the gastrointestinal or biliary tract are most often infected with S. aureus or streptococci. Such wounds can be safely managed with drainage, culture of the wound, irrigation, loose packing with gauze, and outpatient antibiotics. Wounds involving the perineum or associated with the gastrointestinal or biliary tract are often infected with multiple organisms, including gram-negative bacteria and anaerobes. Parenteral broad-spectrum antibiotics are administered, and admission is necessary.
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