The Role of Abdominal Drain Cultures in Managing Abdominal Infections

Abstract

Intra-abdominal infections (IAI) are common in hospitalized patients, both in and outside of the intensive care unit. Management principles include antimicrobial therapy and source control. Typically, these infections are polymicrobial, and intra-operative samples will guide the targeted antimicrobial therapy. Although the use of prophylactic abdominal drains in patients undergoing abdominal surgery is decreasing, the use of drains to treat IAI, both in surgical and non-surgical strategies for abdominal infection, is increasing. In this context, samples from abdominal drains are often used to assist in antimicrobial decision making. In this narrative review, we provide an overview of the current role of abdominal drains in surgery, discuss the importance of biofilm formation in abdominal drains and the mechanisms involved, and review the clinical data on the use of sampling these drains for diagnostic purposes. We conclude that biofilm formation and the colonization of abdominal drains is common, which precludes the use of abdominal fluid to reliably diagnose IAI and identify the pathogens involved. We recommend limiting the use of drains and, when present, avoiding routine microbiological sampling.

Bacteria Living in Biofilms in Fluids: Could Chemical Antibiofilm Pretreatment of Culture Represent a Paradigm Shift in Diagnostics?

“…When employed with a prosthesis, the heightened risks associated with periprosthetic infection and its related complications argue against their use [ 45 ]. Taking into account the perfect culture medium that clotted blood is, along with the addition of a foreign entity in the form of the drain, biofilm formation may clearly occur very quickly [ 13 ]. As for prevention, even for this reason, drains should be used as little as possible—if at all feasible, for no more than 24 h—while being well supervised.…”

“…It has been observed recently that bacteria can form biofilms in fluids such as synovial fluid, urine, cerebrospinal fluid, blood, mucus, saliva, and feces [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Numerous environmental elements further influence the biofilm development process in biological fluids: bacterial adhesion, microcolony formation, and maturation can be impacted by variables like pH, oxygen tension, temperature, and fluid shear forces [ 14 ].…”

“…Microorganisms 2024, 12, 259 2 of 13 One important initial step in the creation of biofilms is the adhesion of bacteria to surfaces. Adherence can happen on artificial surfaces like medical devices as well as on biological surfaces like host tissues.…”

Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM

“…from a specimen collected in a sterile manner from an abdominal, mediastinal, or pleural space or abscess/empyema after alteration of the gastrointestinal or urogenital wall integrity (perforation/surgery). Specimens should preferably be obtained during surgery or from a ultrasound (US)-guided or computerized tomography (CT)-guided aspirate or from a newly inserted drain no later than 24 h after placement [ 41 ]. However, contamination of specimens obtained from colonized drains should always be considered.…”

Antimicrobial Challenge in Acute Care Surgery

“…Intra-abdominal drains paradoxically may promote surgical site infections [ 161 ] and increase hospital length of stay and costs [ 162 , 163 ] in several emergency scenarios, namely acute appendectomies, or cholecystectomies. De Waele et al recommended a limited duration of abdominal drains in the treatment of abdominal sepsis, a prompt drain removal once the source has been controlled, and to avoid culturing drains upon removal [ 164 ].…”