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1、CHAPTER12SURGICALINFECTIONSANDANTIBIOTICUSEPhilipS.BarieDrainsandcathetersmustbeavoided,ifpossible,andremovedriskfactorsforinfectionassoonaspracticable.Prophylacticandtherapeuticantibiotics,infectioncontrolwhetherempiricalordirectedagainstaknowninfection,shouldspecificinfectionsbeusedspari
2、nglytominimizeantibioticselectionpressureonantibioticusethedevelopmentofmultidrug-resistant(MDR)pathogens.disease-,pathogen-,andantibiotic-specificEachoftheseaspectsisdiscussedindetail.considerationsantibiotictoxicitiesRISKFACTORSFORINFECTIONimportantpathogensofcriticallyillpatientsfungali
3、nfectionsHostFactorsThehostisdefinedbygenotype,expressedphenotypicallyascharacteristictraits.Innateimmunityprovidescontinuoussur-veillanceagainsttissueinvasionbyforeignantigensintheinter-Traditionally,surgicalinfectionshavebeenconsideredtobestitialspacesjustbeneathepithelialbarriers.Potent
4、ialpathogensthosethatrequiresurgicaltherapy(e.g.,complicatedintra-areubiquitousintheenvironment,butalthoughcolonizationabdominalinfections[cIAIs]andskinorsofttissueinfectionsofepitheliaoccurseveninhealthyhosts,invasiongenerally[cSSTIs]).However,surgicalpatientsareparticularlyvulnerablerequ
5、iresaportalofentry,whichforsurgicalpatientsmighttonosocomialinfections,soamoreexpansivedefinitionincludesincludeinjuredtissue,incision,puncturesiteforvascularaccess,anyinfectionthataffectssurgicalpatients.Examplesofinfec-orindwellingcatheter.Injuryalsostimulatesarepairresponsetionsthatmayc
6、omplicateperioperativecareincludesurgicalsite(inflammation),whichmaycauseawide-rangingautodestruc-infections(SSIs),centralline–associatedbloodstreaminfectionstiveaugmentationoftheinflammatoryresponse.(CLABSIs),urinarytractinfections(UTIs),andhospital-orThephenotypicstressresponseaugmentsca
7、rdiovascularventilator-associatedpneumonia(HAP,VAP).Thischaptertakesfunctionthroughtheautonomicnervoussystem,promotesgly-themoreencompassingview,recognizingthatthesurgicalcogenolysis,catabolizesperipheralleantissueandfatforgluco-patientisatparticularriskfornos
