Fistula output microorganism-susceptible antimicrobial prophylaxis is associated with a lower risk of surgical site infection in gastrointestinal fistula patients undergoing one-stage definitive surgery.
BACKGROUND
Empiric broad-spectrum antimicrobial prophylaxis (AMP) may not be sufficient to minimize the risk of surgical site infections (SSIs) after definitive surgical treatment of gastrointestinal (GI) fistula. This study investigates whether AMP targeted toward fistula microbiology is associated with a lower risk of SSIs in GI fistula patients undergoing one-stage definitive surgery.


METHODS
Fistula output was sampled from the abdominal fistula opening for microbial growth and drug sensitivity prior to surgery. The primary outcome measure was the overall incidence rate of SSIs.


RESULTS
A total of 191 patients were examined. Pre-operative microbial culture identified microbial growth in 149 patients (76.0%). Post-operative SSIs occurred in 51 patients (26.7%). Risk index category, abdominal incision length, and time of peritoneal drain removal had significantly negative impacts on SSIs frequency. Sensitive AMP agents were associated with a significantly lower risk of SSIs, compared with insensitive AMP agents, but with a similar risk to indefinite AMP agents (23.2% vs. 45.2% vs. 23.1%; odds ratio [95% confidence interval]: 2.724 [1.063, 6.979], p=0.034; 1.008 [0.467-2.177], p=0.984).


CONCLUSIONS
Antimicrobial prophylaxis targeted toward fistula output AMP may minimize the occurrence of SSIs after one-stage definitive surgical treatment of GI fistula.
Department of General Surgery, Jin Ling Hospital , Nanjing, China .
Yue-Ping
YP
Fan
Jian-An
JA
Ren
Yun-Zhao
YZ
Zhao
Guo-Sheng
GS
Gu
Kun
K
Zhao
Jie-Shou
JS
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001419:Bacteria / Q000302:isolation & purification; D016154:Digestive System Fistula / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents