Vermeidung und Therapie von Wundinfektionen in der Abdominalchirurgie

Postoperative surgical site infections after abdominal surgery are a relevant problem for patients and healthcare systems. Alongside pneumonia and urinary tract infections, surgical site infections are among the most common nosocomial infections in these patients. While the patient-related risk factors are mostly difficult to influence in the short-term, there are some modifiable, surgery-related risk factors (e.g., duration of surgery, sterile technique, blood loss) as well as various perioperative preventive measures with different evidence levels (e.g., skin disinfection, intravenous perioperative antibiotic prophylaxis, use of wound edge protectors, prophylactic wound irrigation, change of instruments and gloves before wound closure, triclosan-coated suture material, negative pressure dressing). Depending on the severity and depth of the infection, the treatment includes opening of the wound, surgical revision with fascial debridement/negative pressure wound therapy or the drainage of intra-abdominal abscesses and appropriate intravenous antibiotics. A relaparotomy for exploration and lavage is indicated in cases of generalized peritonitis.