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Wound infection: causes and pathogenesis
Last reviewed: 19.10.2021
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The main pathogens of wound infection are currently Gram-positive aerobic cocci - Staphylococcus aureus (up to 90% of the entire wound infection), other types of staphylococci, as well as streptococci; Gram-negative aerobic flora (intestinal and pseudomonas aeruginosa) is less common.
In patients operated on for chronic purulent diseases (all complicated forms of purulent inflammatory diseases in gynecology), associative flora with a predominance of Gram-negative (intestinal and Pseudomonas aeruginosa) is more often identified.
Pathogenesis of wound infection
- Primary infection of subcutaneous tissue by pathogenic pathogens.
- Secondary infection (suppuration of the hematomas of the anterior abdominal wall, perineum, etc.).
The incidence of wound infection after uterine extirpation is 11.3%.
The risk factors for the development of wound infection, in their opinion, are:
- thickness of subcutaneous tissue;
- level of protein in the blood plasma;
- weight and height-weight index.
However, the authors consider the most significant risk factor for the development of wound infection to be the thickness of the subcutaneous tissue. So, none of the patients with a thickness of subcutaneous tissue less than 3 cm had no wound infection.
In our opinion, the main risk factors for the development of wound infection are:
- obesity;
- Decompensated diabetes mellitus;
- anemia of moderate and severe severity;
- prolonged hospitalization before surgery (or repeated hospitalization);
- prolonged (more than 2.5 hours), traumatic surgery, massive intraoperative blood loss;
- excessive use of coagulation;
- hemostasis defects.
In surgical hospitals and intensive care units, highly virulent hospital strains-coagulase-negative staphylococci, enterococci, Pseudomonas aeruginosa, etc.-are of great importance in wound suppuration. Suppuration occurs after colonization of the skin and wound by hospital strains with a decrease in the resistance of the organism. Nosocomial infections "are characterized by unpredictable antibiotic resistance in accordance with the practice of using antimicrobials in this department or institution." Nosocomial infections are extremely difficult to treat, with reserve antibiotics in place to produce a clinical effect.