PubMed · 15687474
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Paul J Sagerman. 2005. Wounds.. https://doi.org/10.1542/pir.26-2-43
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Among the three types of soft tissue and skins infections (cellulitis, necrotising cellulitis and necrotising fasciitis) only the necrotising injuries are commonly managed in intensive care unit. Location, depth and severity of these potentially life threatening infections may vary and cannot be predicted on clinical grounds No microbiological deduction can be made from clinical signs. A mixed aerobic-anaerobic flora is cultured in 40 to 80% of the cases. Magnetic resonance imaging and CT-scan are the best techniques to assess the diagnosis and determine the extension of infection. However, these exams should not delay surgical treatment. Fifteen to 30% of the patients die. Three parameters play a key role in the prognosis: ability of the physician to recognise the disease and to evaluate the severity of infection, early onset of antimicrobial therapy, and most of all early surgical debridement.
SUMMARY: Three cases of serious eye infection (two endophthalmitis, one orbital cellulitis; two caused by Staphylococcus aureus, one caused by viridans streptococci) occurred shortly after surgery (two cataracts, one retinal detachment repair) within two weeks. There had been construction work adjacent to the theatres during this time, and fine dust was found on horizontal surfaces. Further surgery was cancelled, the construction work was completed and theatres were cleaned before recommencing with no further infections. Following a review of factors that may be involved in the pathogenesis of endophthalmitis, it is proposed that the mechanism of infection in these cases may have been due to the presence of foreign material enhancing the pathogenicity of the small numbers of organisms often found in intra-ocular fluids during surgery. This hypothesis could be tested in experimental models of endophthalmitis.
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