We Japanese Surgeon reduced postoperative MRSA infection rate after outbreak in 1980’s, because of new methods for strict use of antibiotics in post-operative phase. Now, the incidence of surgical complications are low in the world among surgical site infections, remote infections（respiratory tract infections, urinary tract infection, antibiotics related enterocolitis, and catheter related blood stream infection）and postoperative death. This manual were planned to keep the level of postoperative management for infections in spite of decreasing surgeon in Japan. I hope to make more progress in postoperative managements.

Surveillance of perioperative infectious complications, an ongoing activity to monitor their incidence, is as important as implementing measures to prevent them. Surveillance of infectious diseases occurring in healthcare facilities is generally conducted according to an already established system. The reason for this is that it is useful to compare the occurrence of infectious diseases （e.g., incidence） among healthcare facilities in order to evaluate their infection prevention measures, and for this purpose, it is necessary to use the same data collection items and the same criteria for the specific infectious diseases. Among perioperative infectious complications, surgical site infection （SSI） is the most common surveillance target. In Japan, surveillance of SSI has gradually become more widespread since around 2000, with approximately 1,000 facilities currently conducting SSI surveillance. This has revealed the incidence of SSI in Japan, and by comparing SSI incidence in the given facility with the overall incidence in Japan, it has become possible to determine whether the number of surgical site infections is high or low at the facility. The comparison requires adjustment for various factors rather than a simple SSI incidence, and this method is also evolving through research.

Abdominal emergencies are a group of abdominal diseases that require a rapid response, including emergency surgery, and are mostly gastrointestinal diseases. Among these, acute inflammatory diseases such as generalized peritonitis and septic shock require emergency surgery and IVR. The incidence of postoperative complications of infection is high in gastrointestinal diseases requiring emergency surgery, and organ/space SSIs such as intra-abdominal abscesses often occur. Postoperative intra-abdominal infections can be serious if not treated early and appropriately. The basics of treatment are antibacterial drug treatment and the adequate control of the infection source. Antimicrobial therapy for emergency abdominal diseases and postoperative intra-abdominal infections often involves the use of broad-spectrum antimicrobial agents, and the increase in the number of drug-resistant bacteria is a problem. In Japan, the number of ESBL-producing bacteria is rapidly increasing, and appropriate antimicrobial use must be conducted in consideration of AMR countermeasures. Local control of the source of infection should be performed by selecting a safe and feasible technique at each institution.

It is well known that nutritional status and infection are closely correlated. Nutritional management is essential for the prevention and treatment of perioperative infections. It is of utmost importance to first assess the nutritional status of the patients and identify who need nutritional treatment. Then optimal nutritional therapy should be provided to those patients. Especially in the upper gastrointestinal surgical patients, they are often malnourished before surgery and postoperative oral intake is often insufficient. Nutrition should be given via the intestine whenever possible. However, if is not possible or inadequate, parenteral nutrition should be used without delay.

Although routine cardiac surgery is clean surgery, surgical site infections (SSIs) can occur. The incidence of deep sternal wound infection(DSWI), which is sternotomyelitis and mediastinitis after median sternotomy, is 0.25〜5%, and the mortality rate is as high as 20〜45%. DSWI is also a problem in terms of length of hospital stay and medical costs. In order to reduce DSWI, we are conducting perioperative infection control while referring to the ERAS（Enhanced Recovery After Surgery）protocol. Perioperative infections reduce patient satisfaction with our surgery, no matter how good the heart condition is. It is important to set a clear goal of preventing the perioperative infections, and to bundle managements that we believe are correct.

In esophagectomy followed by reconstruction for cancer（esophageal cancer surgery）, postoperative infectious complication（PIC）is a poor prognosticator for long-term as well as short-term outcome. In recent years, thoracoscopic/robot-assisted minimally invasive esophagectomy（MIE）has become widespread, and helped reduce surgical site infection（SSI）not associated with anastomotic failure（AF）and pneumonia as remote infection. However, the incidence of organ/space SSI due to AF is still high, and countermeasures are essential for improving the prognosis.Until now, in addition to treatment-related factors such as surgery, patient factors such as advanced age, malnutrition, and comorbidities have been identified as risk factors for developing PIC, but there is little evidence of countermeasures due to differences in treatment methods among facilities. In the MIE era, in addition to safe surgery with few AFs, infection control with team medical care, including individualized perioperative management according to risk, early diagnosis and appropriate treatment of complications, and appropriate use of antibiotics, is required. In the future, the spread of preventive medicine and social nutrition to minimize the risk factors for PIC in patients diagnosed with esophageal cancer will also become one of the infection control measures in a broad sense.

In Japan, proportion of elderly people is very high in gastric cancer patients who are candidates for gastrectomy. Patients with advanced gastric cancer often suffer from malnutrition before surgery, and often cannot eat enough food after gastric cancer surgery. Decreased physical strength due to aging and malnutrition promotes decreased immune function, impaired sputum excretion, aspiration, and etc., which may lead to increased risk of postoperative pneumonia and anastomotic dehiscence. Surgical site infection (SSI) is less common than colorectal surgery however pancreatic fistula may occur as a complication of lymph node dissection which may form an intra-abdominal abscess making treatment difficult. It is important to perform perioperative infection control measures based on these characteristics of gastric surgery.

Colorectal procedure is one of the most frequent occurrences of surgical site infections in gastrointestinal surgeries. We show the perioperative management for prevention of surgical infection. In other words, we explain about perioperative oral care, preoperative bowel preparation, antimicrobial prophylaxis, antiseptic of surgical field, and instrument change.

A summary of infection control measures during the perioperative period in liver resection surgery is provided. The minimum essence is introduced for trainee doctors. There are precautions at each stage before, during, and after the surgery, and only when all are integrated can a safe liver resection be performed. The introduction of liver resection pathways and preoperative, intraoperative, and postoperative preventive measures for complications are presented.

Surgery for biliary tract diseases includes hepatectomy with biliary reconstruction for gallbladder cancer and hilar cholangiocarcinoma and cholecystectomy for cholelithiasis and acute cholecystitis. Preoperative, intraoperative, and postoperative infection control including systemic management, optimal administration of antibacterial drugs, and control of the source of infection is necessary to reduce infectious complication in biliary tract surgery. Since biliary tract infections sometimes lead to serious condition such as sepsis, early diagnosis and treatment of infection are important for safe biliary tract surgery.

Perioperative management of distal pancreatectomy will be described based on actual practice at the Department of Gastroenterological Surgery, Osaka University. Distal pancreatectomy allows patients to be discharged from the hospital in a relatively short period of time after surgery if there are no complications such as pancreatic fistula. It is important in the postoperative management of distal pancreatectomy to shorten the length of hospital stay while using a clinical path, as well as to prevent complications from becoming more severe by appropriately managing drains.

The perioperative management of pancreaticoduodenectomy （PD） is outlined. Complications after PD are bound to occur, and it is important to detect them early and take measures to prevent them from becoming fatal. This lecture will explain the essentials of PD management, focusing on the perioperative management actually performed at Toyonaka Municipal Hospital. How to prevent failure to rescue is an important factor in this procedure.

The scope of this manual includes trunk trauma, burns, and skin and soft tissue infections. In this manual, our perioperative infection control practices were placed as the “expert opinion” and as the framework for the text, and we conducted a literature search of randomized controlled trials, systematic reviews, meta-analyses, and guidelines reported over the past 20 years. Our treatment strategy was also compared with the “Practical Guidelines for the Appropriate Use of Antimicrobial Agents for Prevention of Surgical Site Infection” published jointly by the Society and the Japanese Society of Chemotherapy, and provided reasons for any differences in our practices. Since our treatment policy is based on the principle of implementing evidence-based medicine, there are no major discrepancies between our strategy and those evidences. In addition, the areas have been paid attention to where evidence is limited, especially in postoperative management, in order to be a reference for the readers.

Acute-phase response affects the general condition in critical ill patients in intensive care and critical care. It is analyzed whether a patient is in urgency and severity in intensive care unit （ICU）. In the process with the damage-associated molecular patterns after surgery, we need to be careful of infectious diseases to prevent pathogen-associated molecular patterns and the augmentation of inflammation and cell death in ICU patients. Intensive care is operated through multidisciplinary collaboration among doctors, nurses, clinical engineers, pharmacists, physical therapists, occupational therapists, speech therapists, registered dietitians, and clerical staff. It needs systemic management of pathology, diagnosis, treatment and infection control in critical ill patients. This article summarizes the consideration and guides in systemic management and infectious disease control in intensive care in Japan.