← Diagnosis and Management Guides
Surgical Site Infection
Key considerations: Deep space infection vs superficial SSI, Anastomotic leak presenting as SSI, Necrotizing fasciitis masquerading as cellulitis
Cannot miss
- Deep space infection vs superficial SSI
- Anastomotic leak presenting as SSI
- Necrotizing fasciitis masquerading as cellulitis
- Mesh infection
Likely diagnoses
- Superficial incisional SSI
- Deep incisional SSI
- Organ/space SSI
- Wound seroma vs infection
Red flags
- Fever >48 hours post-op
- Wound erythema tracking proximally
- Crepitus (gas in tissue)
- Rapidly spreading infection
- Systemic sepsis signs
- Pain out of proportion
Workup
- history: Post-operative day, type of surgery, implanted materials, diabetes, immunosuppression; exam: Wound inspection and probing, erythema measurement, fluctuance, crepitus, wound drainage; labs: CBC, CRP, wound culture (deep tissue preferred); Blood cultures if systemically unwell; imaging: CT scan if deep space infection suspected; LRINEC score if necrotizing fasciitis suspected; bedside: Wound probing, serial exam measurements
Management
- immediate: Necrotizing fasciitis: emergency surgical debridement within hours; general: Superficial SSI: open wound, wound care, antibiotics only if cellulitis extends >2cm; Deep SSI: CT-guided drainage or surgical re-exploration; Mesh infection: often requires mesh removal; Antibiotic selection based on wound culture results
Disposition
- admit: Deep SSI or systemic sepsis, suspected necrotizing fasciitis; discharge: Superficial SSI with close outpatient follow-up; consults: Surgery for re-exploration, ID for complex infections
Clinical pearls
- SSI classification: superficial incisional (skin/subcutaneous), deep incisional (fascia/muscle), organ/space (deepest, most serious)
- Post-op day guides likely pathogen: day 1-2 (Strep/Clostridial), day 3-5 (gram-negatives), day 5-7 (Staph)
- LRINEC score >=6 suggests necrotizing fasciitis — clinical suspicion must guide surgical exploration
Source and review
- CDC SSI Prevention Guidelines 2024. Last reviewed: 2024-11-01