Principles of managing surgical site infections

For minor skin infections, measures such as surgical drainage and irrigation with sodium chloride 0.9% are often adequate for cure. Antibiotic therapy is necessary for:

• skin infection with associated cellulitis or infection of the subcutaneous tissues (see here)
• infection of the deep soft tissues (eg fascia, muscles) or infection with systemic features (see here)
• surgical site infection associated with sepsis or septic shock (for definitions of sepsis and septic shock, see here for adults, or here for neonates, infants and children; for antibiotic choice, see here).

Collect samples for Gram stain and culture before starting antibiotic therapy. More severe surgical site infections (including those involving the deep soft tissues) may require surgical exploration, drainage, irrigation and debridement; delayed wound closure is often necessary.

Advice on managing postoperative organ/space infection (involving structures deeper than the fascia or muscle) is included elsewhere in these guidelines (eg peritonitis due to perforated viscus, mediastinitis, arthroplasty device infection, infected aneurysm, vascular graft or stent infection).

Do not use topical antibiotics for surgical site infections, because they are associated with the emergence of resistant organisms and can cause hypersensitivity reactions. Topical antiseptics do not offer an advantage over drainage and debridement, and cytotoxic antiseptics (eg sodium hypochlorite, hydrogen peroxide) can impede wound healing.