Direct Peritoneal Resuscitation in Critically Ill Patients with an Open Abdomen is Associated with Increased Risk of Intraperitoneal Fungal Infections.

Abstract

Background: Damage control laparotomy (DCL) is a well-established tool to stabilize critically ill surgical patients. Direct peritoneal resuscitation (DPR), whereby the open abdomen is continuously irrigated with glucose-based hypertonic dialysate, is a valuable adjunct that improves abdominal closure rates and decreases wound complications. Infectious implications of its use remain underexplored. Objective: To assess the impact of DPR on the incidence intra-abdominal fungal infections (AFIs) in critically ill surgical patients. Methods: A retrospective chart review was performed of trauma and emergency general surgery patients undergoing DCL with and without DPR at our level 1 trauma center. The effect of DPR on the primary outcomes was assessed using two-stage logistic regression models. Classification and Regression Tree (CART) models were used to evaluate the leading factors contributing to the primary outcome. Results: A total of 169 patients were included in the study, 44% of which underwent DPR. Overall, patients who underwent DPR received a more frequent diagnosis of AFIs (28% vs. 13%, p = 0.012). After multi-variable adjustment, patients undergoing post-operative DPR had significantly higher odds of developing AFI (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 1.3-18.5). In hybrid-logit CART models, DPR was again identified as being associated with an increased likelihood of developing AFI (OR = 2.4, 95% CI: 1.0-6.0). Conclusion: In this cohort, DPR patients had significantly higher chances of developing AFIs. This supports the need for further investigation into the clinical implications of AFIs in critically ill surgical patients and the need to develop risk mitigating strategies.