Surgical Site Infection / Post-op Infection

• CC: Fever, wound erythema/drainage after surgery

• PP: Incisional pain, warmth, purulence, wound dehiscence, fever, abscess

• PN: No deep abdominal/chest symptoms unless organ-space infection concern

• pertinent SHx: Recent surgery/date/procedure, implants/hardware

• Etiology: Superficial incisional, deep incisional, or organ-space infection

• risk factors: Diabetes, obesity, smoking, immunosuppression, prolonged surgery, prosthetic material

• initial DATA: CBC, CMP, lactate if septic, blood cultures if febrile/septic, wound culture if drainage

• pending DATA: CT/US if abscess or organ-space infection suspected

• prior data: Op note, surgical complications, drains/hardware

• MEDS: Recent peri-op antibiotics, anticoagulation, steroids/immunosuppression

• COURSE:

Plan:

• Notify/consult surgical team early

• Open/drain wound if purulent collection or dehiscence per surgery

• Antibiotics:

  • Superficial mild cellulitis: Cefazolin IV or Cephalexin PO

  • MRSA risk/purulence: Vancomycin IV

  • GI/GU/perineal surgery or organ-space concern: Piperacillin-tazobactam

  • Severe/MDR: Vancomycin + Meropenem

• Imaging:

  • US/CT if abscess, deep infection, organ-space infection, persistent fever

• Source control: drainage/debridement/hardware evaluation

• Trend CBC/CMP/fever curve/wound exam

• Hold anticoagulation if procedure likely when safe

• Duration:

  • Superficial cellulitis: ~5–7 days

  • Deep/organ-space: depends on drainage/source control, often 4–7+ days after control