Atypical surgical infections.

The management of infections requiring surgical drainage or debridement is a significant component of surgical education and practice. Standard Gram's stain and culture techniques usually allow ready identification and adjunctive therapy of the offending organism; however, the surgical patient population is changing. More patients who require surgery are elderly, critically ill, have been exposed to broad-spectrum antibiotics, or are otherwise immunosuppressed. We identified 33 infections in this group of 32 patients. The majority of the etiologic agents were not identified using traditional microbiologic techniques, often leading to a delay in diagnosis. In this high-risk group of patients, we recommend histologic study of tissue with special stains such as methenamine silver. When the patient's condition warrants, frozen sections can be used. Optimal outcome requires early recognition of the specific etiologic agent.