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3 Identification, Addressing, and Following Up on Surgical Site Infection After Cranial Cruciate Ligament Stabilization
Katie L. Hoddinott, J. Scott Weese, and Ameet Singh
3.1 Introduction
Prompt and accurate diagnosis of surgical site infections (SSIs) is important for patient management and facility infection control. Identifying infections promptly allows for early intervention. Differentiation of SSI from inflammation helps avoid unnecessary treatment. A good understanding of infection rates and early identification of increases in infection rates can allow for an earlier investigation and intervention. Therefore, SSI surveillance is a critical area for any surgeon, surgical team, and facility.
3.2 Identification of Surgical Site Infections
A superficial incisional SSI is confined to the skin and subcutaneous tissues of the incision and must be differentiated from cellulitis. The Centers for Disease Control and Prevention (CDC) defines cellulitis as localized redness, heat, and swelling, without purulent discharge or identification of microorganisms [1]. The clinical features associated with cellulitis are often identified in postoperative wounds and presumed to indicate SSI without performing diagnostic testing to identify a causative organism, thus confirming an active SSI [2, 3]. Subsequently, when reviewing the literature, a category such as “infection‐inflammation” may be reported, making it difficult to accurately detect and report SSI rates based on CDC definitions [2, 3]. One such study including the infection‐inflammation category defines infection‐inflammation as the presence of purulent discharge, a localized abscess or fistulous tract associated with the incision or the presence of three or more of the following: redness, swelling, heat, pain, serous discharge, and dehiscence [3]. While some of the cases collected in this category may appropriately represent an SSI, it does not distinguish SSI from cellulitis and as such may be falsely increasing the reported SSI rates. Other studies have reported SSI rates based on CDC definitions including positive culture results, while also reporting an infection‐inflammation rate to encompass those patients presenting with abnormal incisions [4].
Early detection and intervention for SSIs is critical. Löfqvist et al. identified marked elevations of serum C‐reactive protein (CRP) and serum amylase A (SAA) 6 days following tibial plateau leveling osteotomy (TPLO) [5]. The cut‐off values reported (CRP >43.9 mg/L, SAA >63.8 mg/L) may be used for patients both with and without clinical evidence of an active SSI and may therefore lead to earlier detection of subclinical SSIs [5]. While these