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Wound infection - Causes and pathogenesis
Medical expert of the article
Last reviewed: 04.07.2025
The main pathogens of wound infection at present are gram-positive aerobic cocci - Staphylococcus aureus (up to 90% of all wound infections), other types of staphylococci, as well as streptococci; gram-negative aerobic flora (intestinal and pseudomonas aeruginosa) are less common.
In patients operated on for chronic purulent diseases (all complicated forms of purulent inflammatory diseases in gynecology), associative flora with a predominance of gram-negative (E. coli and Pseudomonas aeruginosa) is more often isolated.
Pathogenesis of wound infection
- Primary infection of the subcutaneous tissue with pathogenic agents.
- Secondary infection (suppuration of hematomas in the anterior abdominal wall, perineum, etc.).
The incidence of wound infection after hysterectomy is 11.3%.
In their opinion, the risk factors for the development of wound infection are:
- subcutaneous tissue thickness;
- plasma protein level;
- weight and height-weight index.
However, the authors consider the thickness of the subcutaneous tissue to be the most significant risk factor for the development of wound infection. Thus, none of the patients with a subcutaneous tissue thickness of less than 3 cm had a wound infection.
In our opinion, the main risk factors for the development of wound infection are:
- obesity;
- decompensated diabetes mellitus;
- moderate to severe anemia;
- long hospitalization before surgery (or re-hospitalization);
- long-term (more than 2.5 hours), traumatic surgery, massive intraoperative blood loss;
- excessive use of coagulation;
- hemostasis defects.
In surgical hospitals and intensive care units, highly virulent hospital strains - coagulase-negative staphylococci, enterococci, Pseudomonas aeruginosa, etc. - play a major role in wound suppuration. Suppuration occurs after colonization of the skin and wound by hospital strains when the body's resistance decreases. Nosocomial infections "are characterized by unpredictable antibiotic resistance in accordance with the practice of using antimicrobial drugs in a given department or institution." Nosocomial infections are extremely difficult to treat, and reserve antibiotics must be used to achieve a clinical effect.