Infections in minimal incision surgery

We have attempted to delineate a logical and rational approach to the recognition and management of postoperative infections. The reader is urged to use the tenets presented strictly as guidelines. Each and every treatment regimen must be tailored to the individual case. The priorities of early detection and treatment as well as the routine ordering of Gram stain and culture and sensitivity studies must never be ignored. The best prevention of bone infection is high serum levels of antibiotic in the early stages of management. Also, medications should have a high osseous perfusion rate. Among these are the cephalosporins, oxacillins, cloxacillins, and penicillins. After making a definitive diagnosis of osteomyelitis, radiographic evidence may be anticipated from 21 days after the start of infection. Bone scans will demonstrate this condition much sooner and allow for earlier treatment. There are two basic requirements for effective antibiotic therapy. The antibiotic chosen must be capable of inhibiting the growth of the agent or agents causing the infection (this requires an identification of the infecting bacteria and the selection of an antibiotic effective against that organism). Secondly, a therapeutically effective concentration of the antibiotic must reach the infected tissues for a sufficient period of time to allow the antimicrobial activity of the compound to be effective. This requires a blood supply capable of delivering the antibiotic in the blood to the affected tissues. Furthermore, the physiologic state of the patient, the nutritional status, and the immunosuppressive systems should be supported by the means necessary to initiate host reactions against the invading organism. Three last principles may be added to this antibiotic prescribing regimen. (1) When using broad-spectrum antibiotics, be constantly aware of the likelihood of superinfection. This is the overgrowth of bacterial organisms present on the skin as normal flora that multiply rapidly when the surrounding flora is destroyed by the broad-spectrum antibiotic. (2) Ancillary measures including heat, elevation, and immobilization should be employed when conditions permit. (3) Always check for allergy before prescribing an antibiotic. There are no certainties in the treatment of infections; the regimens may change daily as newer and more effective medications are marketed. Nonetheless, the principles remain unchanged. Clinical disease results only when the invading agent evokes anatomic and functional damage in the course of obtaining the necessary requirements for survival.(ABSTRACT TRUNCATED AT 400 WORDS)