Surg Infect (Larchmt)
2 Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas.
Published: April 2017
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.
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http://dx.doi.org/10.1089/sur.2016.205 | DOI Listing |
J Med Internet Res
January 2025
Knight Foundation of Computing & Information Sciences, Florida International University, Miami, FL, United States.
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View Article and Find Full Text PDFJAMA Netw Open
January 2025
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Importance: Women who use heroin in sub-Saharan Africa face elevated HIV risk linked to structural vulnerability including frequent incarceration. However, little is known about the association between incarceration and drug use and HIV outcomes among women who use heroin in Africa.
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JAMA Netw Open
January 2025
Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Importance: Literature suggests that well-being and health status differ by generational status among Asian American individuals.
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J Pers Soc Psychol
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Department of Psychology, University of Arizona.
Women are widely assumed to be more talkative than men. Challenging this assumption, Mehl et al. (2007) provided empirical evidence that men and women do not differ significantly in their daily word use, speaking about 16,000 words per day (WPD) each.
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Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), Trinity College, Dublin, Ireland and UCSF, USA.
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