【正文】 omy. ? Vascular surgery of the lower extremities or abdominal aorta. ? Amputation of an extremity with impaired blood supply, particularly in the presence of a current or recent ischemic ulcer. ? Vaginal or abdominal hysterectomy. ? Primary cesarean section. ? Operations entering the oral pharyngeal cavity in continuity with neck dissections. ? Craniotomy. ? The implantation of any permanent prosthetic material. ? Any wound with known gross bacterial contamination. ? Accidental wounds with heavy contamination and tissue damage. ? Injuries prone to clostridial infection. ? In the presence of preexisting valvular heart damage. Use of antibiotic For mild infections, including most that can be handled on an outpatient basis, this may be achievable with oral antibiotics when appropriate choices are available. For severe surgical infections, however, the systemic response to infection may make gastrointestinal absorption of antibiotics unpredictable. In addition, for intraabdominal infections, gastrointestinal function is often directly impaired. For these reasons, most initial antibiotic therapy for surgical infections is begun intravenously. If obvious improvement is not seen within 2 to 3 days, one often hears the question, “ Which antibiotic should we add/switch to ?” . Following question should be addressed: ? The initial operative procedure was not adequate. ? The initial procedure was adequate but a plication has occurred. ? A superinfection has developed at a new site. ? The drug choice is correct , but not enough is being given. ? Another or a different drug is needed. When to stop antibiotic therapy? ? A reliable guideline is to continue antibiotics until the patient has shown an obvious clinical improvement based on clinical examination and has had a normal temperature for 48 hours or more. ? Signs of improvement include improved mental status, return of bowel function, and spontaneous diuresis. ? For deepseated or poorly localized infections, longer treatment may be needed. ? The white blood cell count may not have returned to normal when antibiotics are stopped. ? If the white blood cell count is normal, the likelihood of further infectious problems is small. . ? If the white blood cell count is elevated, further infections may be detected. In this case, the best approach is to stop the existing drugs and observe the patient closely for subsequent developments. Superinfection Superinfection is a new infection that develops during antibiotic treatment for the original infection. Whenever antibiotics are used, they exert a selective pressure on the endogenous flora of the patient and on exogenous bacteria that colonize sites at risk. Bacteria that remain are resistant to the antibiotics being used bee the pathogens in superinfection. . The best preventive action is to limit the dose and duration of antibiotic treatment to what is obviously required and to be alert to the possibility of superinfections. Superficial Infection ? Furuncle: acute suppurate infection of single folliculus pili with its glandulae sebaceae ? Furunculosis: many furuncles occur together or repeated relapse in the body ? Carbuncle: acute suppurate infection of mutiplefolliculus pili with its glandulae sebaceae Infection of hand ? Paronychia ? Felon ? Acute suppurate peritendinitis ? Deep space infection of palm Deep infection of palm Erysipelas Summary ? Grasp manifestation and treatment of acute suppurate infection, paronychia and tetanus ? Familiar with the onset , development and general rule of treatment on surgical infection manifestation and treatment of sepsis and bactericemia End