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Question 4#

A patient with necrotizing pancreatitis undergoes computed tomography (CT)-guided aspiration, which results in growth of Escherichia coli on culture. The most appropriate treatment is:

a. Culture-appropriate antibiotic therapy
b. Endoscopic retrograde cholangiopancreatography with sphincterotomy
c. CT-guided placement of drain(s)
d. Exploratory laparotomy

Correct Answer is D


The primary precept of surgical infectious disease therapy consists of drainage of all purulent material, debridement of all infected, devitalized tissue, and debris, and/or removal of foreign bodies at the site of infection, plus remediation of the underlying cause of infection. A discrete, walled-off purulent fluid collection (ie, an abscess) requires drainage via percutaneous drain insertion or an operative approach in which incision and drainage take place. An ongoing source of contamination (eg, bowel perforation) or the presence of an aggressive, rapidly spreading infection ( eg, necrotizing soft tissue infection) invariably requires expedient, aggressive operative intervention, both to remove contaminated material and infected tissue (eg, radical debridement or amputation) and to remove the initial cause of infection (eg, bowel resection).