title: Infections following damage control laparotomy with abdominal packing.
abstract: Our objective was to describe postoperative infections for patients undergoing damage control laparotomy (DCL) with abdominal packing. We retrospectively reviewed data on packing patients in Jinling hospital (China) during a 5-y period. Of 26 patients, 15 (57.7%) had postoperative infections. Pneumonia/lower respiratory tract infection (57.7%), bacteraemia (50%), and urinary tract infection (15.4%) were the 3 prominent types of infections. The most frequently isolated bacteria were Pseudomonas aeruginosa (20.7%), staphylococcal species (15.6%), Acinetobacter baumannii (13.9%), and Klebsiella species (11.1%). Antibiotic resistance was common both for the Gram-positive and Gram-negative isolates. No statistical correlation was demonstrated between positive packs and postoperative infection (p=0.10) or death (p=1.00). Multivariate regression analysis revealed pre-existing abdominal infection (OR=22.4, p=0.02) and increased number of surgical procedures (OR=3.69, p=0.05) to be independent risk factors for postoperative de novo infection. We conclude that patients undergoing DCL with packing carry a high incidence of postoperative infections. Causative pathogens are typical for ICU acquired infections and are often associated with low levels of susceptibility to multiple antimicrobial agents. Pre-existing abdominal infection and increased number of surgical procedures are the independent risk factors for postoperative de novo infection in these patients.
authors.affiliation: Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
authors.forename: Wen-Bo
authors.initials: WB
authors.lastname: Zhang
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Wang
authors.forename: Ge-Fei
authors.initials: GF
authors.lastname: Wang
authors.forename: You-Sheng
authors.initials: YS
authors.lastname: Li
authors.forename: Jie-Shou
authors.initials: JS
authors.lastname: Li
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors