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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2015

Open Access 01-12-2015 | Research article

Microbial colonization of open abdomen in critically ill surgical patients

Authors: Suvi Kaarina Rasilainen, Mentula Panu Juhani, Leppäniemi Ari Kalevi

Published in: World Journal of Emergency Surgery | Issue 1/2015

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Abstract

Introduction

This study was designed to describe the time-course and microbiology of colonization of open abdomen in critically ill surgical patients and to study its association with morbidity, mortality and specific complications of open abdomen. A retrospective cohort analysis was done.

Methods

One hundred eleven consecutive patients undergoing vacuum-assisted closure with mesh as temporary abdominal closure method for open abdomen were analyzed. Microbiological samples from the open abdomen were collected. Statistical analyses were performed using Fisher’s exact test for categorical variables. Mann-Whitney U test was used when comparing number of temporary abdominal closure changes between colonized and sterile patients. Kaplan-Meier analysis was done to calculate cumulative estimates for colonization. Cox regression analyses were performed to analyze risk factors for colonization.

Results

Microbiological samples were obtained from 97 patients. Of these 76 (78 %) were positive. Sixty-one (80 %) patients were colonized with multiple micro-organisms and 27 (36 %) were cultured positive for candida species. The duration of open abdomen treatment adversely affected the colonization rate. Thirty-three (34 %) patients were colonized at the time of laparostomy. After one week of open abdomen treatment 69, and after two weeks 76 patients were colonized with cumulative colonization estimates of 74 % and 89 %, respectively. Primary fascial closure rate was 80 % (61/76) and 86 % (18/21) for the colonized and sterile patients, respectively. The rate of wound complications did not significantly differ between these groups.

Conclusions

Microbial colonization of open abdomen is associated with the duration of open abdomen treatment. Wound complications are common after open abdomen, but colonization does not seem to have significant effect on these. The high colonization rate described herein should be taken into account when primarily sterile conditions like acute pancreatitis and aortic aneurysmal rupture are treated with open abdomen.
Literature
1.
Ivatury RR. Update on open abdomen management: achievements and challenges. World J Surg. 2009;33:1150–3.PubMedCrossRef
2.
Duff JH, Moffat J. Abdominal sepsis managed by leaving abdomen open. Surgery. 1981;90:774–8.PubMed
3.
Bosscha K. Open management of abdomen and planned reoperations in severe bacterial peritonitis. Eur J Surg. 2000;166:44–9.PubMedCrossRef
4.
Steinberg D. On leaving the peritoneal cavity open in acute generalized suppurative peritonitis. Am J Surg. 1979;137:216–20.PubMedCrossRef
5.
6.
Ivatury RR, Diebel L, Porter JM, Simon RJ. Intra-abdominal hypertension and the abdominal compartment syndrome: review. Surg Clin North Am. 1997;77:783–800.PubMedCrossRef
7.
8.
Schein M, Saadia R, Decker GG. The open management of the septic abdomen. Surg Gynecol Obstet. 1986;163:587–92.PubMed
9.
10.
Ramsay PT, Meija VA. Management of enteroatmospheric fistulae in the open abdomen. Am Surg. 2010;76:637–9.PubMed
11.
Marinis A, Gkiokas G, Argyra E, Fragulidis G, Polymeneas G, Voros D. “Enteroatmospheric fistulae” – gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique. Scand J Surg. 2013;102:61–8.PubMedCrossRef
12.
Miller RS, Morris Jr JA, Diaz Jr JJ, Herring MB, May AK. Complications after 344 damage control open celiotomies. J Trauma. 2005;59:1371–4.
13.
Leppäniemi A, Tukiainen E. Planned hernia repair and late abdominal wall reconstruction. World J Surg. 2012;36:511–5.PubMedCrossRef
14.
Tsuei BJ, Skinner JC, Bernard AC, Kearney PA, Boulanger BR. The open peritoneal cavity: etiology correlates with the likelihood of fascial closure. Am Surg. 2004;70:652–6.PubMed
15.
Vogel TR, Diaz JJ, Miller RS, May AK, Guillamondequi OD, Guy JS, et al. The open abdomen in trauma; do infectious complications affect primary abdominal closure? Surg Infect (Larchmt). 2006;7:433–41.CrossRef
16.
Garner GB, Ware DN, Cocanour CS, Duke JH, McKinley BA, Kozar RA, et al. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomen. Am J Surg. 2001;182:630–8.PubMedCrossRef
17.
Stonerock CE, Bynoe RP, Yost MJ, Nottingham JM. Use of a vacuum-assisted closure device to facilitate abdominal closure. Am Surg. 2003;69:1030–4.PubMed
18.
Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma. 2000;48:201–6.PubMedCrossRef
19.
Petersson U, Acosta S, Björck M. Vacuum-assisted wound closure and mesh-mediated fascial traction—a novel technique for late closure of the open abdomen. World J Surg. 2007;31:2133–7.PubMedCrossRef
20.
Acosta S, Bjarnason T, Petersson U, Pålsson B, Wanhainen A, Svensson M, et al. Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg. 2011;98:735–43.PubMedCrossRef
21.
Rasilainen SK, Mentula PJ, Leppäniemi AK. Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients. Br J Surg. 2012;99:1725–32.PubMedCrossRef
22.
23.
Horwood J, Akbar F, Maw A. Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. Ann R Coll Surg Engl. 2009;91:681–7.PubMedCentralPubMedCrossRef
24.
Shah SK, Jimenez F, Letourneau PA, Walker PA, Moore-Olufemi SD, Stewart RH, et al. Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome. Scand J Trauma Resusc Emerg Med. 2012;3:20–5.
25.
Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I Definitions Intensive Care Med. 2006;32:1722–32.CrossRef
26.
Goussous N, Kim BD, Jenkins DH, Zielinski MD. Factors affecting primary fascial closure of the open abdomen in the nontrauma patient. Surgery. 2012;152:777–83.PubMedCrossRef
27.
Pliakos I, Michalopoulos N, Papavramidis TS, Arampatzi S, Diza-Mataftsi E, Papavramidis S. The effect of vacuum-assisted closure in bacterial clearance of the infected abdomen. Surg Infect (Larchmt). 2014;15:18–23.CrossRef
28.
Solomkin JS, Mazuski J. Intra-abdominal sepsis: newer interventional and antimicrobial therapies. Infect Dis Clin North Am. 2009;23:593–608.PubMedCrossRef
29.
Montravers P, Gauzit R, Muller C, Marmuse JP, Fichelle A, Desmonts JM. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intra-abdominal surgery affects the efficacy of empiric antimicrobial therapy. Clin Infect Dis. 1996;23:486–94.PubMedCrossRef
30.
Montravers P, Dupont H, Gauzit R, et al. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006;34:646–52.PubMedCrossRef
31.
Burnett RJ, Haverstock DC, Dellinger EP, Reinhart HH, Bohnen JM, Rptstein OD, et al. Definition of the role of enterococcus in intraabdominal infection: analysis of a prospective randomized trial. Surgery. 1995;118:716–21.PubMedCrossRef
32.
Sitges-Serra A, López MJ, Girvent M, Almirall S, Sancho JJ. Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg. 2002;89:361–7.PubMedCrossRef
33.
Eggimann P, Francioli P, Bille J, Schneider R, Wu MM, Chapuis G, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med. 1999;27:1066–72.PubMedCrossRef
34.
Rotondo MF, Schwab CW, McGonical MD, Phillips 3rd GR, Fruchterman TM, Kauder DR, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82.PubMedCrossRef
35.
Diaz Jr JJ, Cullinare DC, Dutton WD, Jerome R, Bagdonas R, Bilaniuk JW, et al. The management of open abdomen in trauma and emergency general surgery: part 1—damage control: review. J Trauma. 2010;68:1425–38.PubMedCrossRef
36.
Bradley MJ, Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, et al. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST Open Abdomen registry. JAMA Surg. 2013;148:947–54.PubMedCrossRef
37.
Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.PubMedCentralPubMedCrossRef
38.
Sörelius K, Wanhainen A, Acosta S, Svensson M, Djavani-Gidlund K, Björck M. Open abdomen treatment after aortic aneurysm repair with vacuum-assisted wound closure and mesh-mediated fascial traction. Eur J Vasc Endovasc Surg. 2013;45:588–94.PubMedCrossRef
Metadata
Title
Microbial colonization of open abdomen in critically ill surgical patients
Authors
Suvi Kaarina Rasilainen
Mentula Panu Juhani
Leppäniemi Ari Kalevi
Publication date
01-12-2015
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2015
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-015-0018-5

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