How should surgical site infections be treated?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In general, infections at surgical sites rarely occur in the first 48 hours after surgery, with the exceptions of group A streptococci or clostridial species. [2] The IDSA indicates that, usually, management with observation, dressing changes, or opening the incision is sufficient in patients with a temperature below 101.3°F (38.5° C) without tachycardia. [2]

Antibiotics and opening the incision are usually required in febrile patients with temperatures above 101.3°F (38.5° C) or tachycardia of 100 beats/min or greater. [2] Empiric therapy with agents active against the most likely organisms (eg, mixed gram-positive/gram-negative organisms for procedures involving the intestinal or genital tract; S aureus, MRSA, and streptococcal organisms for procedures involving nonintestinal sites) can be initiated until results from Gram stain and wound cultures are received. [2]

Procedures that involve nonsterile tissue (eg, intestinal/genital tract, respiratory mucosa) are frequently necessary because of mixed aerobic and anaerobic organism and can involve deeper soft tissues such as fascia and muscle. [2] The IDSA guidelines provide an algorithm, as well as a table of antibiotic selections, based on the operative site. [2]


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