Temporary Abdominal Closure is Associated with Increased Risk for Fungal Intraabdominal Infections in Trauma Patients

Author(s):
Christina X Zhang; Rohit Rasane; Qiao Zhang; Ricardo Fonseca; Jose Aldana; Javier Rincon; Maya Sorini; Kelly Marie Bochicchio; Jennifer Leonard; Obeid Ilahi; Grant Bochicchio

Background:

Fungal infections are associated with increased morbidity and mortality. Few studies have examined risk factors associated with post-operative (post-op) fungal intraabdominal infections (FIAIs) in trauma patients after exploratory laparotomy (ex-lap).

Hypothesis:

We hypothesize that trauma patients undergoing exploratory laparotomy are at an increased risk of developing post-op FIAIs.

Methods:

This was a retrospective analysis of trauma patients admitted from 2005 to 2018 who underwent ex-lap and subsequently developed intraabdominal infection (IAI). Demographics, comorbidities, culture data, antimicrobial/fungal usage, ISS scores, and clinical outcomes were abstracted. All post-op IAIs were evaluated and stratified as either bacterial, fungal, combined, and with or without colonization.  All groups were compared. Risk factors for the development of post-op IAI and clinical outcomes were analyzed by student’s t-test and chi-square test.

Results:

1675 patients were identified as having undergone a trauma ex-lap in which 161 were suspicious for post-op IAI. A total of 105 patients (6.2%) were diagnosed with IAI. 40 (38%) of these patients were diagnosed with FIAIs.  The most common fungal pathogens were unspeciated yeast (62.5%) followed by c. albicans (60%), c. glabrata (7.5%), c. dubliniensis (5%), and c. tropicalis (5%). There were no significant differences in demographics, comorbidities, and percentage of gastric perforations between FIAI and bacterial IAI (BIAI) groups. However, patients with FIAIs had a 75% temporary abdominal closure (TAC) rate compared to 51% in BIAIs (p=0.01). The FIAI group had higher ISS (27 vs. 22, p=0.03), longer hospital (34 vs 25, p=0.02) and ICU days (17 vs 9, p=0.006), and ventilator days (8 vs 4, p=0.02) when compared to BIAI. The FIAI group also had a 5 fold greater mortality. Logistic regression identified TAC as an independent risk factor for the development of post-op FIAIs (OR 4.5, CI 1.1-17.4, p=0.01).

Conclusions:

FIAI following ex-lap was associated with greater morbidity and mortality. TAC was independently associated with increased risk of FIAI after trauma ex-lap. Clinicians should have a high index of suspicion for fungal infections in patients who develop post-op IAI after using TAC techniques for trauma patients undergoing ex-lap.