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Microbial colonization of open abdomen in critically ill surgical patients.

Rasilainen SK, Juhani MP, Kalevi LA - World J Emerg Surg (2015)

Bottom Line: The rate of wound complications did not significantly differ between these groups.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Abdominal Surgery, Jorvi Hospital, Turuntie, 150 Espoo, Finland.

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.

No MeSH data available.


Related in: MedlinePlus

A Kaplan-Meyer plot for the cumulative colonization of new microbes during the TAC treatment. The time point of the last and negative microbial sample is marked with a plus sign (=censored)
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Fig2: A Kaplan-Meyer plot for the cumulative colonization of new microbes during the TAC treatment. The time point of the last and negative microbial sample is marked with a plus sign (=censored)

Mentions: Ninety-seven of the 111 patients had samples taken for bacterial and fungal cultures from the OA. Seventy-six (78 %) patients had positive bacterial culture at least in one sample. Sixty one (80 %) were colonized with multiple micro-organisms and 27 (36 %) were cultured positive for candida species. The median time to colonization from laparostomy was two days. The duration of the OA adversely affected the colonization rate. Thirty-three (34 %) patients were colonized at the time of laparostomy. After one week and two weeks with OA, 69 and 76 patients were colonized with cumulative colonization estimates of 74 % and 89 %, respectively (Fig. 1). Both patients with SAP or RAAA/AAA were significantly less primarily colonized (p = 0.001 and p = 0.002, respectively) compared to the overall study population. Instead, patients with peritonitis had a significantly greater amount of primary colonization (p = 0.001). Figure 2 shows Kaplan-Meier curve of appearance of new microbes after beginning of open abdomen treatment.Fig. 1


Microbial colonization of open abdomen in critically ill surgical patients.

Rasilainen SK, Juhani MP, Kalevi LA - World J Emerg Surg (2015)

A Kaplan-Meyer plot for the cumulative colonization of new microbes during the TAC treatment. The time point of the last and negative microbial sample is marked with a plus sign (=censored)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4487573&req=5

Fig2: A Kaplan-Meyer plot for the cumulative colonization of new microbes during the TAC treatment. The time point of the last and negative microbial sample is marked with a plus sign (=censored)
Mentions: Ninety-seven of the 111 patients had samples taken for bacterial and fungal cultures from the OA. Seventy-six (78 %) patients had positive bacterial culture at least in one sample. Sixty one (80 %) were colonized with multiple micro-organisms and 27 (36 %) were cultured positive for candida species. The median time to colonization from laparostomy was two days. The duration of the OA adversely affected the colonization rate. Thirty-three (34 %) patients were colonized at the time of laparostomy. After one week and two weeks with OA, 69 and 76 patients were colonized with cumulative colonization estimates of 74 % and 89 %, respectively (Fig. 1). Both patients with SAP or RAAA/AAA were significantly less primarily colonized (p = 0.001 and p = 0.002, respectively) compared to the overall study population. Instead, patients with peritonitis had a significantly greater amount of primary colonization (p = 0.001). Figure 2 shows Kaplan-Meier curve of appearance of new microbes after beginning of open abdomen treatment.Fig. 1

Bottom Line: The rate of wound complications did not significantly differ between these groups.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Abdominal Surgery, Jorvi Hospital, Turuntie, 150 Espoo, Finland.

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.

No MeSH data available.


Related in: MedlinePlus