On postoperative day 5, an otherwise healthy 55-year-old man recovering from a paial hepatectomy is noted to have a fever of 38.6degC (101.5degF). Which of the following is the most common nosocomial infection postoperatively?
On postoperative day 5, an otherwise healthy 55-year-old man recovering from a paial hepatectomy is noted to have a fever of 38.6degC (101.5degF). Which of the following is the most common nosocomial infection postoperatively?
💡 Explanation
## **Core Concept**
The question tests knowledge of common nosocomial infections following surgical procedures, specifically partial hepatectomy. Nosocomial infections, also known as hospital-acquired infections, are a significant concern in postoperative care. The type of infection often depends on the type of surgery, patient factors, and the hospital environment.
## **Why the Correct Answer is Right**
The correct answer, **Urinary Tract Infection (UTI)**, is the most common nosocomial infection postoperatively. This is because urinary catheters, commonly used during and after surgery, increase the risk of introducing bacteria into the urinary tract. The risk factors for UTIs in this context include the use of an indwelling urinary catheter, duration of catheterization, and the patient's overall health status. UTIs are often caused by gram-negative bacteria such as *Escherichia coli*.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While pneumonia is a significant nosocomial infection, especially in patients on mechanical ventilation or with pre-existing lung disease, it is not the most common type postoperatively in general.
- **Option B:** Surgical site infections (SSIs) are a concern after any surgical procedure, including partial hepatectomy. However, they are not as common as UTIs when considering all types of nosocomial infections postoperatively.
- **Option C:** Bloodstream infections can occur postoperatively, often related to central venous catheters or the surgical site itself. However, they are less common than UTIs.
- **Option D:** While other infections like Clostridioides difficile (C. diff) can occur postoperatively, especially with antibiotic use, UTIs remain the most prevalent.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the use of urinary catheters should be limited to the duration necessary to reduce the risk of UTIs. Guidelines recommend removing urinary catheters as soon as they are no longer necessary to prevent such infections.