Book Review

Surgical Infections

N Engl J Med 1995; 332:1586June 8, 1995

Article

Surgical Infections
Edited by Donald E. Fry. 787 pp., illustrated. Boston, Little, Brown, 1994. $89.95. ISBN: 0-316-29426-8

Surgical Infections is an attractive book. The quality of the paper, diagrams, and x-ray images adds to its readability. As I flipped through the table of contents to get a sense of the book's scope and organization, I was impressed by the encyclopedic sweep of the chapter headings. All the usual subjects are covered, and organization of the topics in 12 sections is not only rational but also quite helpful to the reader.

Over the years, I have heard Donald Fry, the editor, give presentations on a wide variety of subjects involving infection. He has always been able to get the attention of the audience in a dramatic fashion. In this book as well, he hammers home the information and his personal views on a number of subjects. In fact, he wrote 15 of the chapters himself. Furthermore, 45 of the contributors, like Fry, are from the University of New Mexico. Despite this homogeneity, there is wide variation throughout the book, fortunately with very few contradictions.

The four chapters in the first section deal with basic issues. This section contains some of the best scholarly presentations in the book. The discussion of altered host defenses is not only up to date and well written but also presented by a leader in the field. The chapter is both sophisticated in its scientific discussions and readable.

Four of the five chapters in the next section, on antimicrobial therapy, were written by the editor. Thus, there is little overlap and no inconsistency in the material presented. The same rhythmic, but occasionally wordy, style moves the reader through the pages. Many of the tables, though useful, are overly exhaustive. But then, this is a reference book.

The section on prevention of surgical infection contains chapters by some outstanding contributors who summarize their own views, yet provide a broad perspective. The chapters on antibiotic prophylaxis and prevention of infection are neither contradictory nor redundant. Clear guidelines or an editor's sharp red pencil, or both, made this section flow well.

In the next few sections one finds subjects that are not often discussed in detail, such as infectious complications of breast surgery, hidradenitis suppurativa, pressure ulcers, and peritonitis from peritoneal dialysis. The chapters on the various surgical specialties vary considerably. Liver and splenic abscesses are given less attention than nosocomial sinusitis. I hope that orthopedists will buy this book, since the chapters on orthopedic infections are comprehensive and have excellent reference lists.

The final two sections of the book are provocative, and perhaps the most valuable. The section on systemic sequelae of infection deals with multiple-organ failure, microbial gastrointestinal translocation, and septic responses without infection. The last is not as well focused as the first two chapters, because when this book was assembled, much of the current information was not available. That the subject is even addressed makes this a forward-looking book.

The final three chapters examine antiendotoxin antibodies, immune modulation, and receptor and mediator blockade. The most recent references are from 1992, yet the field has moved rapidly since that time. Nevertheless, the authors of these chapters provide useful information.

Did I like this book? I liked it a lot. Is it perfect? No; there is noticeable variation in depth and quality among the chapters. Will the book be used? Undoubtedly it will, because it provides so much useful and well-organized information.

Jerry M. Shuck, M.D., D.Sc.
Case Western Reserve University, Cleveland, OH 44106