title: Sonication of Abdominal Drains: Clinical Implications of Quantitative Cultures for the Diagnosis of Surgical Site Infection.
abstract: BACKGROUND
  The use of drains in patients undergoing abdominal surgery has been a subject of debate for several decades. In this paper, the usefulness of quantitative cultures of sonicated abdominal drains for diagnosing surgical site of infection (SSI) and the association between culture results with patient outcome is evaluated.
  
  
  METHODS
  Forty-five abdominal drainage tubes from 35 patients who underwent abdominal surgery were studied. Samples were sonicated for 5 min, the sonicate was centrifuged, and the sediment was cultured on different media. Total bacterial counts were adjusted to the actual surface of the drainage tubing. Clinical information of the patients was reviewed retrospectively.
  
  
  RESULTS
  A relation was observed between SSI and the use of drains for more than 3 d (p = 0.0216). The presence of a suspected pathogen was related to the prevalence of SSI (p = 0.035), complications (p = 0.013), and greater leukocyte count (p = 0.048 Mann Whitney test), as well as to the use of drains for more than 3 d (p = 0.0386) and to the serous appearance of the exudates at the point of insertion of the drain (p = 0.0399). The sonication procedure showed a sensitivity of 50%, specificity of 84.2%, positive predictive value of 72.72%, and negative predictive value of 66.67% in the diagnosis of SSI. The most commonly isolated group of organisms was coagulase-negative staphylococci, being present in 18 patients (51.43%) who, however, were not associated with SSI. One or two organisms considered as pathogens were detected in 11 patients (31.43%). The more common pathogens detected were Enterobacteriae spp. (nine patients): Enterobacter aerogenes (2), Enterobacter cloacae (1), Escherichia coli (4), Klebsiella pneumoniae (1), Morganella morganii (1); and Pseudomonas aeruginosa (five patients). Candida spp. and Enterococcus spp. were detected in one patient each one.
  
  
  CONCLUSIONS
  The detection and quantification of organisms not present in skin microbiota after drain sonication is helpful in the diagnosis of SSI and it is associated with a worse outcome in patients. Duration of use of drainage tubes is an independent risk factor for the development of SSI.
authors.affiliation: 1 Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Laura
authors.initials: L
authors.lastname: Prieto-Borja
authors.affiliation: 1 Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz , Madrid, Spain .|2 Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital , Helsinki, Finland .
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez-Tanoira
authors.affiliation: 3 Department of Surgery, IIS-Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Dennis-César
authors.initials: DC
authors.lastname: Levano-Linares
authors.affiliation: 3 Department of Surgery, IIS-Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Angel
authors.initials: A
authors.lastname: Celdrán
authors.affiliation: 4 Department of Epidemiology, IIS-Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahillo-Fernández
authors.affiliation: 1 Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Jaime
authors.initials: J
authors.lastname: Esteban
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology; D004322:Drainage / Q000379:methods; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013010:Sonication / Q000379:methods*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult