Soft tissue infections Done by Abdulhadi T Gelaidan

Soft tissue infections Done by : Abdulhadi T. Gelaidan Supervised by ; Dr. Majed Mansouri

Content of lecture: • Antibiotics use

Content of lecture: • Antibiotics use • Relation between infection and body.

Content of lecture: • Antibiotics use • Relation between infection and body. • Important bacteria in General surgery.

Content of lecture: • Antibiotics use • Relation between infection and body. • Important bacteria in General surgery. • Important antibiotics in G. S.

Content of lecture: • Antibiotics use • Relation between infection and body. • Important bacteria in General surgery. • Important antibiotics in G. S. • Types of soft tissue infections

Antibiotics use • Prophylaxis : indications - Increase in risk of infect. -Wound classes. -Infection = Disaster e. g : infected heart valve

What are the risk of infection?

What are the risk of infection? • • • Wound classes Immune deficiency Medications steroids Chronic illness Nutritions Old Age

Wound classifications

Wound classifications • Clean wounds

Wound classifications • Clean wounds • Clean-contaminated

Wound classifications • Clean wounds • Clean-contaminated • Contaminated

Wound classifications • • Clean wounds Clean-contaminated Contaminated Dirty

Risk of infection • • • Wound classes Immune deficiency Medications steroids Chronic illness Nutritions Old Age

Risk of infection 2 -Infection agent : -Virulence -Numbers 1 -Host : -Diet – vit. C. -Extreme age. -Chronic illness. -D. M, CLD, CRF -Medications: Steroid -Impaired immunity: HIV 3 -Battle ground wound : -Ischemia -Necrosis -Gangreneous -Decrease WBC , Abs

Important Bacteria in G. S COCCi Gram + ve : Gram – ve : BACILLI Gram + ve : Gram – ve :

Important Bacteria in G. S COCCi Gram + ve : BACILLI Gram + ve : - Stapylococci -Streptcocci -Enterococcus -Peptostreptococcus Gram – ve :

Important Bacteria in G. S COCCi Gram + ve : BACILLI Gram + ve : - Stapylococci -Streptcocci -Enterococcus -Peptostreptococcus Gram – ve : -Acinetobacter -Moraxella -Neisseria Gram – ve :

Important Bacteria in G. S COCCi Gram + ve : - Stapylococci BACILLI Gram + ve : -bacillus -clostridium -Streptcocci -corynebacterium -Enterococcus -lactobacillus -Peptostreptococcus -Listeria -Propinobacterium Gram – ve : -Acinetobacter -Moraxella -Neisseria Gram – ve :

Important Bacteria in G. S COCCi Gram + ve : - Stapylococci BACILLI Gram + ve : -bacillus -clostridium -Streptcocci -corynebacterium -Enterococcus -lactobacillus -Peptostreptococcus -Listeria -Propinobacterium Gram – ve : -Acinetobacter -Pseudomonas -Helicobacter -Campylobactur -E. coli -Fusobacterium -Proteus -Shigella -Prevottella -Salmonella -Providencia -Klebsilla -Serratia -Vibrio -Bacteroids -Yersinia -Moraxella -Neisseria -Bartonella -Bordetella -Brucella -Francisella -Hemophilus -Legionella -Pasteurella

Important Bacteria in G. S G+ve Anaerobic - Clostridium tetani - Clostridium perfringes - Clostridium defficuili - Clostridium botulinium G-ve Anaerobic -Bacteroides -Fusobacterium -Prevotella

Common antibiotics Penecillin Macrolides Others -Combined Tazocine Tazopactum Bactrim Septrin Cephalosporine Antibiotics Aminoglycosides Fluoroquinolones carmabenum

Penecillins • Bacteria coverage : Gram (+) Cocci, C. perfringens. • Used in: cellulites & carbuncle Synthetic & combined

But what are the problem with PENECILLINS ?

But what are the problem with PENECILLINS ? • Limited spectrum

But what are the problem with PENECILLINS ? • Limited spectrum • Resistance

Cephalosporine Action: cell wall inhibitors. Cephalosporines 1 st generation 2 nd gene. PC-TRX 3 rd gene. Any cef. Out of PC-TRX 4 th gene. Cefazoline Cephalexin cefadroxil Cefprozil PO Cefaclor Cefotetan Cefuroxime I. M-I. V Cefoxitin Ceftazidime which Pass through BBB Cefepime Mainly Gram + G-, G+, Anaerobic Mainly Gram - G-, Anaerobic Pseudomonus, Anaerobic

Aminoglycosides • Bacteria coverage : G (+)cocci & G ( - )bacilli • Sub group : Gentamicin, Tobramycin , Amikacin , Neomycin , Streptomycin • Execreted by: kidney • Side effects: Renal toxicity and Ototoxicity

Fluoroquinolones Nalidixic acid, Ciprofloxacine, Norfloxacin, Ofloxacin , Moxifloxacin , Levofloxacin • G(- ve) • Most active against pseudomonas Macrolides Subtypes: Azithromycine, Erythromycine , Clarithromycin , Telithromycin Bacteria coverage : G (+)cocci & G ( - )bacilli

Carbapenems Bacteria coverage : Broad spectrum Subtypes: merupenum - imipenem Contra indication: panceriatitis-seizure – not allowed to given by doctors less than R 5

Clindamycine Bacteria coverage: Anaerobic & G +ve cocci

Vancomycine • Bacteria coverage : MRSA, G + ve. • Used in: prosthetic valve , dialysis catheter

Augmantin combination antibiotic containing amoxicillin trihydrate, a βlactam antibiotic, with potassium clavulanate, a βlactamase inhibitor. This combination results in an antibiotic with an increased spectrum of action and restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.

Bactrim (septrin) • combination of trimethoprim and sulfamethoxazole

Tazocin • Piperacillin is an extended spectrum beta-lactam antibiotic of the ureidopenicillin class. • It is normally used together with a beta-lactamase inhibitor such as tazobactam. The combination drug of piperacillin and tazobactam • Its main uses are in intensive care medicine (pneumonia, peritonitis), some diabetes-related foot infections and empirical therapy in febrile neutropenia (e. g. after chemotherapy).

Soft tissue infections Superficial (skin and subcutanous) : -Boils -Folliculitis -Impetigo -Erysipelas -Cellulitis -Abcess -Carbuncle Deep ( Fascia & Muscle) : -Necrotizing Fasciitis -Gas gangrene Organs : -Cholecystitis -Appendicitis

Soft tissue infections

Superficial (skin and subcutanous) 1 - Boils : it is infection of single hair follicle 2 - Folliculitis is a infection of group of hair follicles;

Impetigo 3 - Impetigo : staphylococcus , streptoccus infection which presented with honey crust skin after blisters rupture. Rx : by direct washing, topical Abcs , oral Abcs

Erysipelas 4 –(localized cellulitis) sharply demarcated streptcoccal infection of lymphatic vessels, usually associated with broken skin on face, erythema, Oedema do --- C/S Rx : broad spectrum Abcs

5 -Cellulitis - Is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken.

6 -Skin Abcess - Is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue in which the pus resides on the basis of an infectious process (usually caused by bacteria or parasites)

7 -Carbuncle - Is an abscess larger than a boil, usually with one or more openings draining pus onto the skin.

Deep ( Muscle & Fascia) 1 - Necrotizing fasciitis : Flesh-eating disease or Flesh-eating bacteria syndrome, is a infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue

Deep ( Muscle & Fascia) 2 – Gas gangrene : is a bacterial infection that produces gas tissues in gangrene. It is a deadly form of gangrene usually caused by anaerobic bacteria. It is a medical emergency.

Deep organs - Appendicitis. - Acute cholecystitis