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01-08-2010 | Original Article

Microbiological Profile and Antimicrobial Susceptibility in Surgical Site Infections Following Hollow Viscus Injury

Authors: Beat Schnüriger, Kenji Inaba, Barbara M. Eberle, Tiffany Wu, Peep Talving, Marko Bukur, Howard Belzberg, Demetrios Demetriades

Published in: Journal of Gastrointestinal Surgery | Issue 8/2010

Abstract

Introduction

The purpose of this study was to assess the microbiological profile, antimicrobial susceptibility, and adequacy of the empiric antibiotic therapy in surgical site infections (SSI) following traumatic hollow viscus injury (HVI).

Methods

This is a retrospective study of patients admitted with an HVI from March 2003 to July 2009. SSI was defined as a wound infection or intra-abdominal collection confirmed by positive cultures and requiring percutaneous or surgical drainage.

Results

A total of 91 of 667 (13.6%) patients with an HVI developed an SSI confirmed by positive culture. Mean age was 33.0 ± 14.1 years, mean Injury Severity Score (ISS) was 17.7 ± 9.6, 91.2% were male, and 80.2% had sustained penetrating injuries. The SSI consisted of 65 intra-abdominal collections and 26 wound infections requiring intervention. The most commonly isolated species in the presence of a colonic injury was Escherichia coli (64.7%), Enterococcus spp. (41.2%), and Bacteroides (29.4%), and in the absence of a colonic perforation, Enterococcus spp. and Enterobacter cloacae (both 38.9%). Susceptibility rates of E. coli and E. cloacae, respectively, were 38% and 8% for ampicillin/sulbactam, 82% and 4% for cefazolin, 96% and 92% for cefoxitin, with both 92% to piperacillin/tazobactam, and 100% to ertapenem. The initial empirical antibiotic therapy adequately targeted the pathogens in 51.6% of patients who developed an SSI.

Conclusion

The distribution of the microorganisms isolated from SSIs differed significantly according to whether or not a colonic injury was present. Empiric antibiotic treatment was inadequate in upwards of 50% of patients who developed an SSI. Further investigation is warranted to determine the optimal empiric antibiotic regimen for reducing the rate of postoperative SSI.

Morales CH, Villegas MI, Villavicencio R, Gonzalez G, Perez LF, Pena AM, Vanegas LE. Intra-abdominal infection in patients with abdominal trauma. Arch Surg 2004;139:1278-1285; discussion 1285.CrossRefPubMed

Salim A, Teixeira PG, Inaba K, Brown C, Browder T, Demetriades D. Analysis of 178 penetrating stomach and small bowel injuries. World J Surg 2008;32:471-475.CrossRefPubMed

Hofstetter SR, Pachter HL, Bailey AA, Coppa GF. A prospective comparison of two regimens of prophylactic antibiotics in abdominal trauma: cefoxitin versus triple drug. J Trauma 1984;24:307-310.CrossRefPubMed

Delgado G, Jr., Barletta JF, Kanji S, Tyburski JG, Wilson RF, Devlin JW. Characteristics of prophylactic antibiotic strategies after penetrating abdominal trauma at a level I urban trauma center: a comparison with the East guidelines. J Trauma 2002;53:673-678.CrossRefPubMed

O'Neill PA, Kirton OC, Dresner LS, Tortella B, Kestner MM. Analysis of 162 colon injuries in patients with penetrating abdominal trauma: concomitant stomach injury results in a higher rate of infection. J Trauma 2004;56:304-312; discussion 312-303.CrossRefPubMed

Croce MA, Fabian TC, Stewart RM, Pritchard FE, Minard G, Kudsk KA. Correlation of abdominal trauma index and injury severity score with abdominal septic complications in penetrating and blunt trauma. J Trauma 1992;32:380-387; discussion 387-388.CrossRefPubMed

Croce MA, Fabian TC, Patton JH, Jr., Lyden SP, Melton SM, Minard G, Kudsk KA, Pritchard FE. Impact of stomach and colon injuries on intra-abdominal abscess and the synergistic effect of hemorrhage and associated injury. J Trauma 1998;45:649-655.CrossRefPubMed

Demetriades D, Lakhoo M, Pezikis A, Charalambides D, Pantanowitz D, Sofianos C. Short-course antibiotic prophylaxis in penetrating abdominal injuries: ceftriaxone versus cefoxitin. Injury 1991;22:20-24.CrossRefPubMed

Nichols RL, Smith JW, Klein DB, Trunkey DD, Cooper RH, Adinolfi MF, Mills J. Risk of infection after penetrating abdominal trauma. N Engl J Med 1984;311:1065-1070.PubMedCrossRef

10.

Kirton OC, O'Neill PA, Kestner M, Tortella BJ. Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days. J Trauma 2000;49:822-832.CrossRefPubMed

11.

Schmidt-Matthiesen A, Roding H, Windolf J, Sommerfeldt D, Gutt C, Pannike A, Encke A. A prospective, randomised comparison of single- vs. multiple-dose antibiotic prophylaxis in penetrating trauma. Chemotherapy 1999;45:380-391.CrossRefPubMed

12.

Tyburski JG, Wilson RF, Warsow KM, McCreadie S. A trial of ciprofloxacin and metronidazole vs gentamicin and metronidazole for penetrating abdominal trauma. Arch Surg 1998;133:1289-1296.CrossRefPubMed

13.

Sims EH, Thadepalli H, Ganesan K, Mandal AK. How many antibiotics are necessary to treat abdominal trauma victims? Am Surg 1997;63:525-535.PubMed

14.

Demetriades D. Antibiotic prophylaxis in penetrating abdominal injuries. S Afr J Surg 1989;Suppl:5.

15.

Fabian TC, Hoefling SJ, Strom PR, Stone HH. Use of antibiotic prophylaxis in penetrating abdominal trauma. Clin Ther 1982;5 Suppl A:38-47.

16.

Montravers P, Gauzit R, Muller C, Marmuse JP, Fichelle A, Desmonts JM. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis 1996;23:486-494.PubMed

17.

Mosdell DM, Morris DM, Voltura A, Pitcher DE, Twiest MW, Milne RL, Miscall BG, Fry DE. Antibiotic treatment for surgical peritonitis. Ann Surg 1991;214:543-549.CrossRefPubMed

18.

Sturkenboom MC, Goettsch WG, Picelli G, in 't Veld B, Yin DD, de Jong RB, Go PM, Herings RM. Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol 2005;60:438-443.CrossRefPubMed

19.

Krobot K, Yin D, Zhang Q, Sen S, Altendorf-Hofmann A, Scheele J, Sendt W. Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community-acquired intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis 2004;23:682-687.CrossRefPubMed

20.

Guembe M, Cercenado E, Alcala L, Marin M, Insa R, Bouza E. Evolution of antimicrobial susceptibility patterns of aerobic and facultative gram-negative bacilli causing intra-abdominal infections: results from the SMART studies 2003-2007. Rev Esp Quimioter 2008;21:166-173.PubMed

21.

Montravers P, Lepape A, Dubreuil L, Gauzit R, Pean Y, Benchimol D, Dupont H. Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study. J Antimicrob Chemother 2009;63:785-794.CrossRefPubMed

22.

Velmahos GC, Vassiliu P, Demetriades D, Chan LS, Murray J, Salim A, Sava J, Katkhouda N, Berne TV. Wound management after colon injury: open or closed? A prospective randomized trial. Am Surg 2002;68:795-801.PubMed

23.

Giannella RA, Broitman SA, Zamcheck N. Gastric acid barrier to ingested microorganisms in man: studies in vivo and in vitro. Gut 1972;13:251-256.CrossRefPubMed

24.

Thadepalli H. Principles and practice of antibiotic therapy for post-traumatic abdominal injuries. Surg Gynecol Obstet 1979;148:937-951.PubMed

25.

Durham RM, Olson S, Weigelt JA. Penetrating injuries to the stomach. Surg Gynecol Obstet 1991;172:298-302.PubMed

26.

Thadepalli H, Lou MA, Bach VT, Matsui TK, Mandal AK. Microflora of the human small intestine. Am J Surg 1979;138:845-850.CrossRefPubMed

27.

Paterson DL, Rossi F, Baquero F, Hsueh PR, Woods GL, Satishchandran V, Snyder TA, Harvey CM, Teppler H, Dinubile MJ, Chow JW. In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART). J Antimicrob Chemother 2005;55:965-973.CrossRefPubMed

28.

Rossi F, Baquero F, Hsueh PR, Paterson DL, Bochicchio GV, Snyder TA, Satishchandran V, McCarroll K, DiNubile MJ, Chow JW. In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends). J Antimicrob Chemother 2006;58:205-210.CrossRefPubMed

29.

Bochicchio GV, Baquero F, Hsueh PR, Paterson DL, Rossi F, Snyder TA, McCarroll K, Satishchandran V, Dinubile MJ, Chow JW. In vitro susceptibilities of Escherichia coli isolated from patients with intra-abdominal infections worldwide in 2002-2004: results from SMART (Study for Monitoring Antimicrobial Resistance Trends). Surg Infect (Larchmt) 2006;7:537-545.CrossRef

30.

Baquero F, Cercenado E, Cisterna R, de la Rosa M, Garcia-Rodriguez JA, Gobernado M, Perez JL, Manchado P, Martin R, Pascual A, Picazo J, Prats G, Rubio C, Snyder TA, Sanz-Rodriguez C. [Patterns of susceptibility to antibiotics of Enterobacteriaceae causing intra-abdominal infection in Spain: SMART 2003 study outcomes]. Rev Esp Quimioter 2006;19:51-59.PubMed

31.

Ko WC, Hsueh PR. Increasing extended-spectrum beta-lactamase production and quinolone resistance among Gram-negative bacilli causing intra-abdominal infections in the Asia/Pacific region: data from the Smart Study 2002-2006. J Infect 2009;59:95-103.CrossRefPubMed

32.

Nijssen S, Florijn A, Bonten MJ, Schmitz FJ, Verhoef J, Fluit AC. Beta-lactam susceptibilities and prevalence of ESBL-producing isolates among more than 5000 European Enterobacteriaceae isolates. Int J Antimicrob Agents 2004;24:585-591.CrossRefPubMed

33.

Sotto A, Lefrant JY, Fabbro-Peray P, Muller L, Tafuri J, Navarro F, Prudhomme M, De La Coussaye JE. Evaluation of antimicrobial therapy management of 120 consecutive patients with secondary peritonitis. J Antimicrob Chemother 2002;50:569-576.CrossRefPubMed

34.

Eagye KJ, Kim A, Laohavaleeson S, Kuti JL, Nicolau DP. Surgical site infections: does inadequate antibiotic therapy affect patient outcomes? Surg Infect (Larchmt) 2009;10:323-331.CrossRef

35.

Solomkin JS, Mazuski JE, Baron EJ, Sawyer RG, Nathens AB, DiPiro JT, Buchman T, Dellinger EP, Jernigan J, Gorbach S, Chow AW, Bartlett J. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis 2003;37:997-1005.CrossRefPubMed

36.

Burnett RJ, Haverstock DC, Dellinger EP, Reinhart HH, Bohnen JM, Rotstein OD, Vogel SB, Solomkin JS. Definition of the role of Enterococcus in intraabdominal infection: analysis of a prospective randomized trial. Surgery 1995;118:716-721CrossRefPubMed

37.

Christou NV, Turgeon P, Wassef R, Rotstein O, Bohnen J, Potvin M. Management of intra-abdominal infections. The case for intraoperative cultures and comprehensive broad-spectrum antibiotic coverage. The Canadian Intra-abdominal Infection Study Group. Arch Surg 1996;131:1193-1201.PubMed

38.

Weigelt JA, Easley SM, Thal ER, Palmer LD, Newman VS. Abdominal surgical wound infection is lowered with improved perioperative Enterococcus and Bacteroides therapy. J Trauma 1993;34:579-584CrossRefPubMed

39.

Sitges-Serra A, Lopez MJ, Girvent M, Almirall S, Sancho JJ. Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg 2002;89:361-367.CrossRefPubMed

40.

Roehrborn A, Thomas L, Potreck O, Ebener C, Ohmann C, Goretzki PE, Roher HD. The microbiology of postoperative peritonitis. Clin Infect Dis 2001;33:1513-1519.CrossRefPubMed

41.

Seguin P, Laviolle B, Chanavaz C, Donnio PY, Gautier-Lerestif AL, Campion JP, Malledant Y. Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy. Clin Microbiol Infect 2006;12:980-985.CrossRefPubMed

42.

Reik R, Tenover FC, Klein E, McDonald LC. The burden of vancomycin-resistant enterococcal infections in US hospitals, 2003 to 2004. Diagn Microbiol Infect Dis 2008;62:81-85.CrossRefPubMed

43.

Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2003;36:1433-1437.CrossRefPubMed

44.

Eliopoulos GM. Quinupristin-dalfopristin and linezolid: evidence and opinion. Clin Infect Dis 2003;36:473-481.CrossRefPubMed

45.

Murray BE. Vancomycin-resistant enterococcal infections. N Engl J Med 2000;342:710-721.CrossRefPubMed

46.

Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, Gaynes R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42:389-391.CrossRefPubMed

47.

Klein E, Smith DL, Laxminarayan R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007;13:1840-1846.PubMed

Title: Microbiological Profile and Antimicrobial Susceptibility in Surgical Site Infections Following Hollow Viscus Injury
Authors: Beat Schnüriger
Kenji Inaba
Barbara M. Eberle
Tiffany Wu
Peep Talving
Marko Bukur
Howard Belzberg
Demetrios Demetriades
Publication date: 01-08-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 8/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-010-1231-x

At a glance: The STEP trials

Springer Medicine

Microbiological Profile and Antimicrobial Susceptibility in Surgical Site Infections Following Hollow Viscus Injury

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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