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Practice Patterns for the Use of Antibiotic Agents in Damage Control Laparotomy and Its Impact on Outcomes.

Abstract The purpose of this study was to identify practice patterns associated with the use of antimicrobial agents with damage control laparotomy (DCL) and the relationship with post-operative intra-abdominal infection (IAI) rates.
PMID
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Authors

Mayor MeshTerms

Practice Patterns, Physicians'

Keywords

antimicrobial

infections

laparotomy

Journal Title surgical infections
Publication Year Start




PMID- 28394751
OWN - NLM
STAT- MEDLINE
DA  - 20170410
DCOM- 20170417
LR  - 20170417
IS  - 1557-8674 (Electronic)
IS  - 1096-2964 (Linking)
VI  - 18
IP  - 3
DP  - 2017 Apr
TI  - Practice Patterns for the Use of Antibiotic Agents in Damage Control Laparotomy
      and Its Impact on Outcomes.
PG  - 282-286
LID - 10.1089/sur.2016.205 [doi]
AB  - BACKGROUND: The purpose of this study was to identify practice patterns
      associated with the use of antimicrobial agents with damage control laparotomy
      (DCL) and the relationship with post-operative intra-abdominal infection (IAI)
      rates. PATIENTS AND METHODS: The study was a retrospective review of trauma
      patients undergoing laparotomy at a Level 1 trauma center in 2010. Patients
      undergoing DCL versus those primarily closed (PCL) were compared for
      antimicrobial use (ABX) and its correlation with IAI rates (p < 0.05). Deaths
      with length of stay <5 days were excluded. RESULTS: A total of 121 patients were 
      identified (28 DCL, 93 PCL). The DCL group was more severely injured (Injury
      Severity Score [ISS]: 31.4 +/- 15 DCL vs. 18 +/- 12.7 PCL, p < 0.001) with more
      small and large bowel injuries (SLBI), although not statistically significant
      (53.6% DCL vs. 35.5% PCL, p = 0.12). Practice patterns of ABX administration in
      terms of pre-operative (94.6% PCL vs. 69.2% DCL, p = 0.0012) and post-operative
      administration (PCL: 50.5% none, 21.5% one day, 28% long term >1 d; DCL: 21.4%
      none, 25.0% one day, 53.6% long term >1 day, p = 0.0130) were significant.
      Regression analyses demonstrated that neither ISS nor DCL was an independent
      predictor of infection, but pre-operative ABX was a negative predictor (odds
      ratio [OR] 0.20, 95% confidence interval [CI] 0.05-0.91, p = 0.037), while
      post-operative ABX (OR 6.7, 95%CI 1.33-33.8, p = 0.044) and SLBI (OR 3.45, CI
      1.03-11.5, p = 0.02) were positive predictors of infection with an receiver
      operating characteristic of 0.81. CONCLUSION: Significant variations exist in the
      use of ABX in DCL and PCL. These variations may lead to deleterious results from 
      both lack of initial pre-operative coverage and prolonged ABX use. The decrease
      in infection rates with pre-operative ABX yet significant increase with continued
      post-operative use even in the presence of SLBI suggests the need for a more
      standardized approach. With the increase in DCL and the open abdomen, more
      research is needed to clearly establish ABX protocols in this patient population.
FAU - Goldberg, Stephanie R
AU  - Goldberg SR
AD  - 1 Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth
      University , Richmond, Virginia.
FAU - Henning, Jennifer
AU  - Henning J
AD  - 1 Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth
      University , Richmond, Virginia.
FAU - Wolfe, Luke G
AU  - Wolfe LG
AD  - 1 Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth
      University , Richmond, Virginia.
FAU - Duane, Therese M
AU  - Duane TM
AD  - 2 Department of Surgery, John Peter Smith Hospital , Fort Worth, Texas.
LA  - eng
PT  - Journal Article
DEP - 20170302
PL  - United States
TA  - Surg Infect (Larchmt)
JT  - Surgical infections
JID - 9815642
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adult
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - Antibiotic Prophylaxis/*methods
MH  - Female
MH  - Humans
MH  - Intraabdominal Infections/*prevention & control
MH  - Laparotomy/*methods
MH  - Male
MH  - Middle Aged
MH  - *Practice Patterns, Physicians'
MH  - Retrospective Studies
MH  - Surgical Wound Infection/*prevention & control
MH  - Treatment Outcome
MH  - Wounds and Injuries/surgery
OTO - NOTNLM
OT  - antimicrobial
OT  - infections
OT  - laparotomy
EDAT- 2017/04/11 06:00
MHDA- 2017/04/18 06:00
CRDT- 2017/04/11 06:00
AID - 10.1089/sur.2016.205 [doi]
PST - ppublish
SO  - Surg Infect (Larchmt). 2017 Apr;18(3):282-286. doi: 10.1089/sur.2016.205. Epub
      2017 Mar 2.

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