Wound infection

Introduction Wound infection is a pathological reaction in which the pathogenic microorganisms grow and multiply in the body after invading the body through the wound, causing the normal function, metabolism, and tissue structure of the body to be destroyed, causing tissue damage. After being attacked by pathogens, the body can mobilize various defense functions to eliminate pathogens and their toxic products to restore the relative stability of the body. Whether the pathogen can cause infection after invading the body depends mainly on the virulence of the pathogen and the resistance of the body.

Cause

All bacteria that cause wound infections are invading tissues causing local changes and systemic poisoning. However, unlike other pathogenic bacteria, the tetanus bacillus does not produce obvious pathological changes in the wound, regardless of the exotoxin produced by the bacteria or its exotoxin. It is caused by the secretion and spread of toxins throughout the body, and the exotoxin is produced. Strong, has a special affinity for nerves, after absorption, distributed in the spinal cord, brain stem, etc., easily endangered life.

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Related inspection

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Although focal cellulitis, myositis and diffuse myogenic necrosis have distinct clinical features that can be identified and treated accordingly. However, detailed surgical exploration of the wound is often required, and the affected tissue can be visually observed to confirm the diagnosis. For example, in muscle necrosis, necrotic muscle tissue can be observed, the affected muscles are dull magenta, and then the deep red is finally grayish green or purple spotted. X-ray examination shows local gas production, and CT and magnetic resonance can help determine the range of gas and necrosis.

Wound exudates should be cultured for anaerobic and aerobic bacteria. Clostridium can be isolated from pure culture or cultured with other anaerobic bacteria or/and aerobics. The smear can be shown as Gram-positive Clostridium. There is almost no polymorphonuclear leukocyte in a typical exudate, and staining with Sudan can reveal free fat globules. Many traumas, especially open trauma, can be contaminated by both pathogenic and non-pathogenic Clostridium without significant invasive disease. The significance of this situation needs to be judged from a clinical perspective.

Clostridium wound infection can be characterized by focal cellulitis, local or diffuse myositis, or the most severe progressive muscular necrosis (gas gangrene). Infection can occur several hours or days after the injury, often in limbs with severe crush injury or tissue necrosis after penetrating injury. Similar diffuse myositis or myogenic necrosis can also occur in surgical wounds, especially occlusion Patients with vascular disease.

Differential diagnosis

Differential diagnosis of wound infections:

Other anaerobic or aerobic bacteria, including Enterobacter and Bacteroides, Streptococcus and Staphylococcus, alone or in combination, can cause severe Clostridium-like cellulitis of traumatic or post-operative wounds, extensive Fasciitis or gas gangrene. If the smear shows a large number of polymorphonuclear leukocytes and a large number of cocci in a chain arrangement, anaerobic streptococcus or staphylococcal infection should be considered. A large number of Gram-negative bacilli may indicate an Enterobacter or Bacteroides infection. Determination of specific antigenic toxins in wounds or blood is only helpful for a small number of cases of botulism obtained through trauma. Clostridium can also occur, but it does not make any sense.

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