Brief Answer:
Further investigation & Detailed evaluation needed

Detailed Answer:
Hi, thanks for posting the concern in the HCM.
From the history, this seems to be a post operative surgical site infection. I am astonished to find out that you have been on Azithromycin for last 20 days. Immediate reconsideration of this management is needed to avoid iatrogenic complications.
Now, surgical site infections can be caused by a number of bacteria. But, an infection for so long a duration compels me to think of Mycobacterium bovis or some azithromycine resistant strain of Staph, or enterococci or pseudomonas. Numerous other organisms are there in the list of causative agents. I have only mentioned those we encounter most in similar clinical settings.
The following tests should be done prior to commencement of treatment:
Complete blood count, CRP, urea, creatinine, HbA1c, fasting/ random blood glucose
USG whole abdomen
Wound swab/scraping gram stain, AFB stain, Culture and sensitivity testing. Any further antibiotic treatment depends on these test results.
If the wound area is really bad, debridement or reexploration may be needed and then keeping the wound open or closed by monofilament sutures are justified.
Please also maintain sterility and ensure the same when care of the local area is taken by some other service provider.
Please also maintain good oral hydration.
A combined advice by a local surgeon and an infectious disease specialist would be the best guide for treatment.
Please don't get scared. This condition is often refractory to simple antibiotic treatment and occurs commonly. But, with proper treatment the outcome is excellent.
If you find the answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar

---

Brief Answer:
Removing the pus is necessary

Detailed Answer:
Hi, thanks for your reply. I think your doctor was right at least in the sense that the pus needs to be removed. The pus gets entrapped in pockets and this becomes the areas unreachable for the antibiotics. So, draining of the pus is absolutely urgently needed. Otherwise the infection would persist, give rise to drug resistant strains, as it has done already, spread and even can give rise to sepsis and multiorgan failure. It's not the surgery that endangers your life in this point of time, it is your fear for surgery which can cause you havoc and believe me the drainage of the pus is a simple surgical procedure that can be life saving at this condition. If you have still any confusion, you can even consult the best surgeon in your city and he/she would tell you the same thing. If you have any problem with the expertise of your local doctor, you can seek treatment from some other surgeon. But, I can tell you that post op complications can happen to any one. It was not your surgeon's expertise which could have precipitated the problem, rather the improper maintenance of sterility protocol was the reason behind it. Now, I again tell you that the line of treatment at this point is draining the pus, obliterating the pus pockets and then sending the sample for culture sensitivity and histopathologic examination. Then start broad spectrum antibiotic therapy with some antibiotic having good anaerobic and gram negative coverage. Change antibiotic from broad spectrum to narrow spectrum as soon as the reports are available. If M. bovis is found treatment will be based on the established guideline.
If you are satisfied with the answer, please close the thread and rate my answer.

---