Infections following damage control laparotomy with abdominal packing

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.