Surgical site and vascular infections: treatment and prophylaxis

Vascular infections typically include those of surgical sites, prosthetic grafts, and vascular ulcers, including some diabetic foot ulcers. Each of these infections represents a serious health concern, particularly among individuals with comorbid conditions who are at an increased risk of morbidity and mortality. Surgical site infections occur primarily as a result of contamination by skin organisms during surgery, whereas prosthetic graft infections result typically from a progressive wound infection. Diabetic foot ulcers and infections are especially complicated and difficult to treat. They occur in individuals with systemic illness that has compromising effects on the nervous, vascular, musculoskeletal, and immunologic systems. Vascular infections, like those elsewhere in the body, reflect an imbalance between the host and bacteria. Efforts to limit or prevent the likelihood of patients developing these infections centre on reducing the bacterial inoculum by means of asepsis and antisepsis. As well as size of the bacterial inoculum, the bacterial properties of pathogenicity and resulting virulence are also significant. The most frequent pathogenic bacteria encountered in surgical patients are Gram-positive cocci (e.g. Staphylococcus aureus and streptococci). Strains with multiple antibiotic resistance (e.g. meticillin resistant S. aureus [MRSA], S. epidermidis, and vancomycin-resistant enterococci [VRE]) can cause significant surgical site infection problems. Local resistance patterns and surveillance efforts are essential to ensure appropriate empiric antibiotic selection for prophylaxis or treatment.