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Predicting surgical infection before the operation

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Abstract

To date, simple skin testing using recall antigens has proven to be the most accurate method of assessing preoperative risk for serious infectious complications. When used in conjunction with measures to control the microorganisms and the environment, evaluation of host defense mechanisms with skin testing can aid in reducing postoperative infectious morbidity and mortality.

There are 3 possible therapeutic approaches to anergic patients. Surgery and specific nonsurgical treatments (restoration of blood volume, red cell mass, antibiotics), total parenteral nutrition, and immunorestoration. The challenge for the future is to develop the criteria that will indicate the most important defects which account for the anergic state in individual patients.

Résumé

A l’heure actuelle, les tests d’hypersensibilité cutanée aux antigènes constituent la meilleure méthode pour apprécier avant l’opération le risque de complications infectieuses graves. Cette estimation des mécanismes de défense par les tests cutanés peut, lorsqu’elle est associée à des mesures de contrôle des micro-organismes et du milieu, réduire la morbidité et la mortalité post-opératoire par infection. Trois attitudes thérapeutiques sont possibles chez le malade anergique: chirurgie et traitements spécifiques non chirurgicaux (rééquilibration du volume sanguin et de la masse globulaire, antibiotiques), nutrition parentérale totale et restauration des défenses immunitaires. Dans l’avenir, il faudra essayer de mettre au point des techniques de détection des déficits responsables de l’anergie.

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References

  1. Meakins, J.L.: Host defense mechanisms: evaluation acquired defects and immunotherapy. Can. J. Surg.18:259, 1975

    CAS  PubMed  Google Scholar 

  2. MacLean, L.D., Meakins, J.L., Taguchi, K., Duignan, J.P., Dhillon, K.S., Gordon, J.: Host resistance in sepsis and trauma. Ann. Surg.182:207, 1975

    CAS  PubMed  Google Scholar 

  3. Meakins, J.L., Pietsch, J.B., Bubenick, O., Kelly, R., Rode, H., Gordon, J., MacLean, L.D.: Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma. Ann. Surg.186:241, 1977

    CAS  PubMed  Google Scholar 

  4. Pietsch, J.B., Meakins, J.L., MacLean, L.D.: The delayed hypersensitivity response: application to clinical surgery. Surgery82:349, 1977

    CAS  PubMed  Google Scholar 

  5. Davidson, A.I.G., Clark, C., Smith, G.: Post-operative wound infection: a computer analysis. Br. J. Surg.58:333, 1971

    CAS  PubMed  Google Scholar 

  6. Cruse, P.J.E., Foord, R.: A five-year prospective study of 23,649 surgical wounds. Arch. Surg.107:206, 1973

    CAS  PubMed  Google Scholar 

  7. Doig, C.M., Wilkinson, A.W.: Wound infection in a children’s hospital. Br. J. Surg.63:647, 1976

    CAS  PubMed  Google Scholar 

  8. Altemeier, W.A., Culbertson, W.R., Hummel, R.P.: Surgical considerations of endogenous infections—sources, types and methods of control. Surg. Clin. North Am.48:227, 1968

    CAS  PubMed  Google Scholar 

  9. Clarke, J.S., Condon, R.E., Bartlett, J.G., Gorbach, S.L., Nichols, R.L., Ochi, S., Cross, G.H., Gordon, H.E., Greenlee, H., Irvin, G.L., III, Johnson, W.C., Jordan, P.H., Jr., Kaplan, M., Mandiola, S., Schulte, W.J., Storm, F.K., Storz, W.: Preoperative oral antibiotics reduce septic complications of colon operations. Ann. Surg.186:251, 1977

    CAS  PubMed  Google Scholar 

  10. Polk, H.C., Lopez-Mayor, J.F.: Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery66:97, 1969

    PubMed  Google Scholar 

  11. Stone, H.H., Hooper, C.A., Kolb, L.D., Geheber, C.E., Dawkins, E.J.: Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann. Surg.184:443, 1976

    CAS  PubMed  Google Scholar 

  12. Wilson, P.D., Salvatti, E.A., Blumenfeld, E.L.: The problem of infection in total prosthetic arthroplasty of the hip. Surg. Clin. North Am.55:1431, 1975

    PubMed  Google Scholar 

  13. Gorbach, S.L.: Antibiotic therapy of obstetric and gynecologic infections. Surg. Clin. North Am.55:1373, 1975

    CAS  PubMed  Google Scholar 

  14. Lindenauer, S.M., Fry, W.J., Schaub, G., Wild, D.: The use of antibiotics in the prevention of vascular graft infections. Surgery62:487, 1967

    CAS  PubMed  Google Scholar 

  15. Condie, J.D., Ferguson, D.J.: Experimental wound infections: contaminations versus surgical technique. Surgery50:367, 1961

    Google Scholar 

  16. Chandra, R.K.: Immunocompetence in undernutrition. J. Pediatr.81:1194, 1972

    Article  CAS  PubMed  Google Scholar 

  17. Neuman, C.G., Lawlor, G.J., Stiehm, E.R., Swendseid, M.E., Newton, C., Herbert, J., Ammann, A.J., Jacob, M.: Immunologic responses in malnourished children. Am. J. Clin. Nutr.28:89, 1975

    Google Scholar 

  18. Alexander, J.W., Meakins, J.L.: A physiologic basis for the development of opportunistic infections in man. Ann. Surg.176:273, 1972

    CAS  PubMed  Google Scholar 

  19. Curreri, P.W., Heck, E.L., Browne, L., Baxter, C.R.: Stimulated nitroblue tetrazolium test to assess neutrophil antibacterial function: prediction of wound sepsis in burned patients. Surgery74:6, 1973

    CAS  PubMed  Google Scholar 

  20. Hiebert, J.M., McGough, M., Rodehaver, G., Tobiasen, J., Edgerton, M.T., Edlich, R.F.: The influence of catabolism on immunocompetence in burned patients. Surgery86:242, 1979

    CAS  PubMed  Google Scholar 

  21. Meakins, J.L., McLean, A.P.H., Kelly, R., Bubenik, O., Pietsch, J.B., MacLean, L.D.: Delayed hypersensitivity and neutrophil chemotaxis: effect of trauma. J. Trauma18:240, 1978

    CAS  PubMed  Google Scholar 

  22. Johnson, W.C., Ulrich, F., Meguid, M.M., Lepak, N., Bowen, P., Harris, P., Alberts, L.H., Nabseth, D.C.: Role of delayed hypersensitivity in predicting postoperative morbidity and mortality. Am. J. Surg.137:536, 1979

    Article  CAS  PubMed  Google Scholar 

  23. Buzby, G.P., Mullen, J.L., Matthews, D.C., Hobbs, C.L., Rusato, E.F.: Prognostic nutritional index in gastrointestinal surgery. Am. J. Surg.139:160, 1980

    Article  CAS  PubMed  Google Scholar 

  24. George, C., Robin, M., Carlet, J., Rapin, M., Landais, C., Sabatier, C.: Tests cutanés explorant l’immunité cellulaire chez les malades en réanimation. Relation entre les résultats et la mortalité. Nouv. Press Med.7:2541, 1978

    CAS  Google Scholar 

  25. Christou, N.V., Meakins, J.L.: Delayed hypersensitivity: a mechanism for anergy in surgical patients. Surgery86:78, 1979

    CAS  PubMed  Google Scholar 

  26. Christou, N.V., Meakins, J.L.: Neutrophil function in surgical patients: neutrophil adherence and chemotaxis and cutaneous anergy. Ann. Surg.190:557, 1979

    CAS  PubMed  Google Scholar 

  27. Zigmond, S.H., Hirsch, J.G.: Leukocyte locomotion and chemotaxis. J. Exp. Med.137:387, 1973

    Article  CAS  PubMed  Google Scholar 

  28. Christou, N.V., McLean, A.P.H., Meakins, J.L.: Host defense in blunt trauma: interrelationships between kinetics of anergy and depressed neutrophil function, nutritional status and sepsis. J Trauma (in press)

  29. Christou, N.V., Meakins, J.L.: Neutrophil function in surgical patients: two inhibitors of granulocyte chemotaxis associated with sepsis. J. Surg. Res.26:335, 1979

    Article  Google Scholar 

  30. Meakins, J.L., Christou, N.V., Shizgal, H.M., MacLean, L.D.: Therapeutic approaches to anergy in surgical patients: surgery and levamisole. Ann. Surg.190:285, 1979

    Google Scholar 

  31. Studley, H.O.: Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. J.A.M.A.106:458, 1936

    Google Scholar 

  32. Rhoads, J.E., Alexander, C.E.: Nutritional problems of surgical patients. Ann. N.Y. Acad. Sci.63:268, 1955

    CAS  PubMed  Google Scholar 

  33. Spanier, A.H., Pietsch, J.B., Meakins, J.L., MacLean, L.D., Shizgal, H.M.: Relationship between immune competence and nutrition. Surg. Forum27:332, 1976

    CAS  PubMed  Google Scholar 

  34. Bistrian, B.R., Blackburn, G.L., Hallowell, E., Heddle, R.: Protein status of general surgical patients. J.A.M.A.230:858, 1974

    Article  CAS  PubMed  Google Scholar 

  35. Hill, G.L., Blackett, R.L., Pickford, L.J., Burkinshaw, L., Young, G.A., Warren, J.V., Schoran, C.J., Morgan, D.B.: Malnutrition in surgical patients: an unrecognized problem. Lancet1:689, 1977

    Article  CAS  PubMed  Google Scholar 

  36. Dionigi, R., Zonta, A., Dominioni, L., Gnes, F., Ballabio, A.: The effects of total parenteral nutrition on immunodepression due to malnutrition. Ann. Surg.185:467, 1977

    CAS  PubMed  Google Scholar 

  37. Law, D.K., Dudrick, S.J., Abdou, N.I.: Immunocompetence of patients with protein-calorie malnutrition. The effects of nutritional repletion. Ann. Intern. Med.79:545, 1973

    CAS  PubMed  Google Scholar 

  38. Law, D.K., Dudrick, S.J., Abdou, N.I.: The effects of dietary protein depletion on immunocompetence. The importance of nutritional repletion. Ann. Intern. Med.179:168, 1974

    CAS  Google Scholar 

  39. Alexander, J.W.: Emerging concepts in control of clinical infection. Surgery75:934, 1974

    CAS  PubMed  Google Scholar 

  40. Christou, N.V., Meakins, J.L., Gotto, D., MacLean, L.D.: The influence of gastrointestinal bleeding on host defense and susceptibility to infection. Surg. Forum30:46, 1979

    CAS  PubMed  Google Scholar 

  41. Hess, L.I., Palmer, D.L.: Anergy in patients with leukocytosis. Am. J. Med.56:323, 1974

    Article  Google Scholar 

  42. Meakins, J.L., Christou, N.V., Hallé, C., MacLean, L.D.: The influence of cancer on host defense and susceptibility to infection. Surg. Forum30:115, 1979

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of Surgery and Microbiology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada

    Jonathan L. Meakins M.D., D.Sc., John B. Pietsch M.D., Nicolas V. Christou M.D., Ph.D. & Lloyd D. Maclean M.D., Ph.D.

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  1. Jonathan L. Meakins M.D., D.Sc.
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  2. John B. Pietsch M.D.
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  3. Nicolas V. Christou M.D., Ph.D.
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  4. Lloyd D. Maclean M.D., Ph.D.
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Supported by Medical Research Council of Canada.

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Meakins, J.L., Pietsch, J.B., Christou, N.V. et al. Predicting surgical infection before the operation. World J. Surg. 4, 439–449 (1980). https://doi.org/10.1007/BF02393171

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  • DOI: https://doi.org/10.1007/BF02393171

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