Surgical wound infections: an overview

Area of Science:

• Surgical infection control
• Medical microbiology
• Immunology

Background:

• Infection control has historically relied on host defense preservation, antisepsis, and asepsis.
• Despite advancements, surgical site infections remain a significant challenge, limiting surgical progress.
• Current methods like asepsis and antisepsis are nearing their maximum effectiveness and face limitations such as cost, resistance, and toxicity.

Purpose of the Study:

• To evaluate the current state and future potential of different infection control strategies in surgery.
• To identify the most promising avenues for future advancements in preventing surgical infections.
• To highlight the need for a "social contract" among surgeons regarding antibiotic use and further research into host defense enhancement.

Main Methods:

• Review of historical and current infection control strategies: host defense preservation, antisepsis, and asepsis.
• Analysis of the limitations and potential for advancement in each strategy.
• Discussion of the role of preventive antibiotics and the need for controlled studies.
• Exploration of enhancing host defenses through nutrition, perfusion, oxygenation, and immune stimulation.

Main Results:

• Asepsis and antisepsis, while crucial, are reaching their technological and application limits.
• Preventive antibiotics face challenges with resistant organisms, toxicity, and cost, necessitating controlled studies and defined usage guidelines.
• Preservation and enhancement of host defenses represent the most underdeveloped yet potentially most fruitful area for infection control advancement.
• Enhancements in host defenses via nutrition, perfusion, oxygenation, and immune stimulation have shown promise in reducing infection rates.

Conclusions:

• Further advancements in asepsis and antisepsis are limited by cost, efficiency, and the emergence of resistant bacteria.
• A collaborative approach among surgeons is needed to optimize the use of preventive antibiotics.
• Enhancing host defenses through nutritional support, improved tissue perfusion, oxygenation, and immune stimulation presents a significant and achievable opportunity for reducing surgical infections.