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Prophylaxis against sepsis in patients undergoing major surgery

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Abstract

Postoperative infection in general surgical patients is discussed according to operation types. A selection of the huge literature on each group is reviewed, and details from the author's own work and ideas are presented. By discussing these points attempts are made to determine the best regimens for a given set of clinical circumstances. There is a small literature indicating that postoperative chest infection can be prevented by some antibacterial drug regimens, and this question has been addressed; it seems that in the past it has been largely ignored. Some nonantibacterial methods of reducing postoperative infection are also briefly discussed.

Résumé

Cet article traite des infections post-opératoires en chirurgie générale. Pour chaque type d'intervention une sélection de l'abondante littérature est passée en revue et des précisions sur la propre étude des auteurs ainsi que leurs idées sur la question sont présentées. En confrontant ces différentes données une conduite à tenir optimale est proposée pour chaque circonstance clinique donnée. Il y a peu d'article dans la littérature concernant la prévention possible des infections respiratoires post-opératoires par l'administration d'antibiotiques et ce point a été souligné puisqu'il semble que cela ait été largement ignoré par le passé. Quelques moyens visant à réduire le nombre d'infections post-opératoires et qui ne font pas appel à des antibiotiques sont également brièvement envisagés.

Resumen

La sepsis es una causa importante y común de morbilidad y mortalidad postoperatorias. Las complicaciones se presentan hasta en 50% de los casos en algunas series, y al tomar información radiológica solamente la incidencia alcanza hasta el 70%. La incidencia no ha cambiado en los últimos 30 años. En el Departamento de Cirugía de la Universidad de Auckland, Australia, la incidencia luego de cirugía abdominal superior ha estado alrededor de 40%, en forma consistente. Existen numerosos factores de riesgo, que incluyen obesidad, enfermedad pulmonar crónica, anestesia prolongada y edad avanzada. La malnutrición ha sido reconocida como factor de riesgo, y un estudio realizado en este departamento señaló que la depleción proteica predispone a complicaciones pulmonares postoperatorias.

El presente artículo se refiere a la infección postoperatoria en pacientes de cirugía general. Los tópicos han sido agrupados de acuerdo al tipo de operación; se ha hecho una relación de la inmensa literatura disponible para cada grupo, y se presentan detalles de los trabajos propios del autor, en un intento por decidir sobre los mejores regímenes profilácticos para cada cuadro clínico en particular. Existe escasa literatura que indique que la infección torácica postoperatoria pueda ser prevenida mediante regímenes antibacterianos, y este aspecto es destacado en el artículo. También se discuten algunos métodos no-antibacterianos en la reducción de la infección postoperatoria.

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  1. University Department of Surgery, Auckland Hospital, Auckland, New Zealand

    W. T. Morris Ph.D., F.R.C.S.

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Morris, W.T. Prophylaxis against sepsis in patients undergoing major surgery. World J. Surg. 17, 178–183 (1993). https://doi.org/10.1007/BF01658924

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