The Effect of Vacuum-Assisted Closure in Bacterial Clearance of the Infected Abdomen

Pliakos, Ioannis; Michalopoulos, Nikolaos; Papavramidis, Theodossis S.; Arampatzi, Stergiani; Diza-Mataftsi, Eudoxia; Papavramidis, Spiros

doi:10.1089/sur.2012.156

Cited by 20 publications

(17 citation statements)

References 33 publications

(42 reference statements)

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“…Although covered with occlusive negative pressure dressings, the laparostomy wound creates a potential route for pathogens to enter the abdominal cavity. In a recent study Pliakos et al [ 27 ] showed in 39 patients with severe abdominal sepsis treated with open abdomen and VAC that 54 % of the patients developed a hospital-acquired peritoneal infection during the VAC-treatment. We observed a similar trend with 34 % of patients being colonized at the primary laparostomy and 89 % after two weeks of OA treatment, although a significant number of our patients had initially a non-contaminated surgical field.…”

Section: Discussionmentioning

confidence: 99%

“…aeruginosa, Enterobacter species and Candida species [ 29 , 30 ], all of which were detected as colonizing pathogens also in the present study. Pliakos et al showed predominance of intestinal bacteria in the OAs of patients treated for peritonitis [ 27 ] many of these also belonging to the previously mentioned families of resistant microbes. In particular, postoperative isolation of Enterococci, observed as the most commonly cultured pathogens from the OAs in the present study, has been associated with treatment failure and death [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Microbial colonization of open abdomen in critically ill surgical patients

2015

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Microbial colonization of open abdomen in critically ill surgical patients

2015

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“…Therefore, we should focus not only on the treatment of primary disease in elderly patients but also take effective measure to treat SAP to significantly improve the life quality and prognosis of patients in Neurosurgery Department. Furthermore, multi-drug resistance bacteria infection [20][21][22] can prolong the hospitalization time of SAP patients increase the hospitalization cost and even increase the mortality [23,24]. Gram-negative bacteria are most common in SAP patients with multi-drug resistance bacteria infection.…”

Section: Discussionmentioning

confidence: 99%

Etiologic Diagnosis and Clinical Treatment of Multiple Drug-Resistant Bacteria Infection in Elderly Patients with Stroke-Associated Pneumonia After Neurosurgery

Liu

Ye²,

Jin

et al. 2014

Cell Biochem Biophys

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Our objective is to analyze the etiology and antibiotics resistance rate of multiple drug-resistant bacteria infection in elderly patients with stroke-associated pneumonia from Neurosurgery Department, providing a reference for clinical treatment. Sputum of 372 elderly patients with stroke-associated pneumonia (SAP) from Neurosurgery Department was collected for sputum culture and drug sensitivity test, and pathogenic bacteria distribution and drug resistance rate of antibiotics were discussed. Among 372 pathogenic bacteria, there were 95 cases with Gram-positive cocci, the percentage was 15.32 %; there were 277 cases with Gram-negative bacilli, the percentage was 59.95 %; there were 54 cases with fungus, the percentage was 14.51 %; the common Gram-positive cocci included Staphylococcus aureus, Staphylococcus haemolyticus and Staphylococcus epidermidis, with percentages of 15.32 %, 2.96 % and 4.30 % respectively; the common Gram-negative bacilli included Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae, with percentages of 23.92 %, 14.25 % and 9.95 % respectively; the highest drug resistance rates of Staphylococcus aureus were 100.00 % to penicillin, erythrocin and oxacillin, the highest drug resistance rate of Staphylococcus epidermidis was 87.50 % to erythrocin, the highest drug resistance rate of Staphylococcus haemolyticus was 100.00 % to penicillin and erythrocin, the lowest drug resistance rates of three Gram-negative bacilli were 0 % to teicoplanin and vancomycin; the highest drug resistance rates of Escherichia coli were 100.00 % to ceftriaxone and ticarcillin, and the lowest drug resistance rate was 11.32 % to ciprofloxacin; the highest drug resistance rate of Pseudomonas aeruginosa was 100.00 % to ceftriaxone, and the lowest drug resistance rate was 22.47 % to imipenem; the highest drug resistance rate of Klebsiella pneumoniae was 81.08 % to aztreonam, and the lowest drug resistance rate was 0.00 % to imipenem. Stroke-associated pneumonia is common clinically in elderly patients from Neurology Department, the early-stage and rational use of antibiotics should be applied according to the etiologic distribution and drug resistance characteristics. Meanwhile, prevention measures should be applied.

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“…In these cases, the minimum required treatment, such as lavage and drainage, is carried out with the abdomen open, followed by general management in the intensive care unit for patients with severe peritonitis. 7,8 Although OAM was originally proposed as a damage-control strategy in patients with severe trauma, the technique has been adapted for non-trauma patients, including those with severe peritonitis. 2,3 In this case, it took 32 days for fascial closure from first laparotomy.…”

Section: N Open Abdominal Drainage For Peritonitis Primarymentioning

confidence: 99%

Successful use of flexible silicone mesh for management of prolonged open abdomen

Tsutsumi

Akahoshi

Ikeda

et al. 2019

Acute Medicine & Surgery

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Background Open abdomen management (OAM) is used not only for trauma but also for treatment of peritonitis. However, the rate of successful fascial closure in patients with OAM remains low. Case Presentation The patient was a 38‐year‐old morbidly obese man who underwent laparoscopic sleeve gastrectomy. Twenty days after surgery, postoperative leakage resulted in panperitonitis. In this case, we undertook drainage by open laparotomy. The patient's status was generally unstable and he was treated with OAM. We used flexible silicone mesh as the dressing material for negative‐pressure wound therapy. Open abdominal management continued until status improvement (32 days). Fascial closure was eventually successful because of good granulation growth. Conclusion When combined with negative‐pressure wound therapy, silicone mesh prevents wound adhesions and infection after surgery. Silicone mesh is useful for patients with increased risk of infection, such as those with diffuse peritonitis.

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The Effect of Vacuum-Assisted Closure in Bacterial Clearance of the Infected Abdomen

Cited by 20 publications

References 33 publications

Microbial colonization of open abdomen in critically ill surgical patients

Microbial colonization of open abdomen in critically ill surgical patients

Etiologic Diagnosis and Clinical Treatment of Multiple Drug-Resistant Bacteria Infection in Elderly Patients with Stroke-Associated Pneumonia After Neurosurgery

Successful use of flexible silicone mesh for management of prolonged open abdomen

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