Manual of Surgical Infections [antikvár]

r 1 I f, I'.i ''I '" / Preface If a surgeon from the last century were to be transported by a time warp to a modem operating room, he would no doubt be lost in the panoply of surgical instruments and electronic monitoring equipment. However, on venturing into the surgical wards this transplanted surgeon would be familiar with the clinical conditions of many of the patients, especially those with woimd suppuration and sepsis. These infectious processes have an eternal character, spanning the centuries, overriding the advances in surgical technique. Since the sixteenth century when Ambroise Paré introduced revolutionary concepts of local care of gunshot injuries—by stopping the practice of pouring boiling oil into the wound—each advance has been accompanied by the hope, always unfulfilled, of eliminating surgical infections. Every development—the listerian principles, the advent of vaccines and immunizations, and most recently, the era of antimicrobial wonder drugs—has improved the outlook for surgical infection, but none has caused the problem to disappear. Indeed, the rates of infection and the outlook for survival with some conditions have not changed substantially in the past half-century. Infection remains a leading cause of morbidity and mortality in surgical patients. This manual represents an effort to restate the traditional approaches to surgical infections, at the same time applying the latest developments in diagnosis, surgical management, and antimicrobial therapy. It is intended to be practical, readable, and, above all, helpful—what was called in ancient times a vade mecum (literally, go with me), to accompany the surgeon on rounds or in the office. We have relied heavily on the recorded literature of surgical infection, but we have also added a measure of our own experience by evaluating the conventional wisdom and by stating our opinions in controversial areas. Above all, we emphasize that neither the surgical blade nor the antimicrobial drug can, in isolation, produce good results in surgical infection. The fbst principle is diagnosis, followed by an intelligent treatment plan that combines judicious surgical intervention with appropriate antimicrobial agents and physiologic support measures. We are grateful to the many colleagues who read portions of the manuscript, contributing their sage advice and encouragement: Michael Barza, M.D., Allan W. Hackford, M.D., John M. Kellum, M.D., Edwin M. Meares, Jr., M.D., and Francis P. Tally, M.D. To David R. Snydman, M.D., we owe a special debt for reviewing the epidemiology sections and contributing the hepatitis section. We are also grateful to the many people who helped in the preparation of the manuscript, including Luci Aran, Allie Broadway, Mary Calderazzo, Joan Donoghue, Florence Hagins, Louise Kelly, Virginia Lindsey, and Jeffrey Smith. Our thanks also go to Tracy Scannell-Keating, who played an important role in putting the manuscript into its final form. The editors of Little, Brown showed great patience during the gestation period and helped us in many ways: Cynthia Baron and Jim Krosschell. While many people have contributed their talents to this endeavor, the authors accept the ultimate responsibility for its veracity. S. L. G. J. G. B. R. L. N. ix