Microbial colonization of open abdomen in critically ill surgical patients

Abstract

IntroductionThis 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.MethodsOne 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.ResultsMicrobiological 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.ConclusionsMicrobial 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.

Prevalence, Distribution, Risk Factors and Antifungal Susceptibility Profiles of Candida Isolates from Patients Attending Mombasa Hospital

“…Surgery was not a statistically significant factor associated with isolation of Candida. These findings were lower compared to a previous study where Candida were observed in 33% of the colonized patients confirming the vulnerability of the critically ill surgical patients to fungal infections (Rasilainen, Juhani, & Kalevi, 2015). The observed difference could be due to the kind of patients selected.…”

The role of open abdomen in non-trauma patient: WSES Consensus Paper

“…Often the OA, particularly if prolonged, results in fascia retraction and consequently in large abdominal wall defects that require complex abdominal wall reconstruction. Moreover, the situation is often complicated by a contaminated field [ 121 ] with high risk of infections and wound complications, such as wound infections, seromas, fistula formation, recurrence of the defect, and mortality [ 122 – 124 ].…”

Optimum Methods for Keeping the Abdomen Open

“…Moreover, leaving the abdomen open for a longer period increases the risk of microbial colonization of the wound. But this has not been shown to increase wound complications or enterocutaneous fistula formation [69].…”