Rationale:

• Bacteria causing infections following clean procedures are likely to be due to S. aureus; MRSA may be an important pathogen here.
• Bacteria causing infections following surgery involving the bowel or perineum are likely to be anaerobes and gram-negative bacilli.
• Drainage of infected wounds is as (or more) important than antimicrobials. Many patients, especially those with superficial incisional abscesses, can be treated by drainage alone without adjunctive antimicrobials.
• A variety of antimicrobials are active in the treatment of surgical infections due to S. aureus following clean surgery as well as gram-negative bacilli following surgery on the gastrointestinal tract.

Evidence:

• For small abscesses <5 cm in diameter, drainage alone is effective without the need for antimicrobials (18; 64).
• Tigecycline is comparable to imipenem in the treatment of complicated intra-abdominal infections (129).

Comments:

• Most surgical site infections become clinically manifest 5 to 20 days postoperatively. If signs appear before 5 days, consider streptococcal or Clostridium infection or staphylococcal toxic shock syndrome as possibilities.