The Impact of a Novel Microbicidal Elastomeric Liquid Polymer (Preventogen) on Surgical Site Infections in Patient Undergoing Surgery

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Authors:
Christy Chai, Hachem Bey, Raymond Lopez, Samir Awad

Body of Abstract:
Background: Surgical site infections (SSI) are the most common hospital acquired infection accounting for 20% with increase in morbidity, mortality and cost. In vitro, Preventogen, a novel elastomeric microbicidal liquid polymer has been shown to actively kill pathogens such as MDRO and Non-MDRO gram positive & negative bacteria, and various fungi on contact through cell lysis; drying within 30 seconds to create a flexible see through film barrier that continues to protect the surgical site for 5-7 days. Previous reports have demonstrated a significant decrease in external fixator pin site infections [Pema, doi:10.15761/CMID.1000177].

Hypothesis: Our objective was to evaluate the impact of Preventogen on SSI rates in patients undergoing general and surgical oncologic procedures. We hypothesized that Preventogen would decrease the risk of SSIs.

Methods: A retrospective review of a prospective data base of patients undergoing elective surgery at a tertiary academic hospital was performed from 7-1-2022 to 10-1-2024. Age, gender, comorbidities (HTN, CHF, COPD, DM, Tobacco, AKI, Ascites, sepsis, functional status, cancer), demographics and procedure CPT codes were collected. Cases were stratified for clean and clean contaminated (CC). For each patient the expected SSI risk was calculated using the validated ACS NSQIP risk calculator (https://riskcalculator.facs.org/RiskCalculator/index.jsp). All patients underwent preoperative decontamination with Chlorhexidine wipes day prior and on day of surgery; all had surgery site appropriate prophylactic antibiotics prior to incision; and all had Chloraprep as the skin prep. Preventogen was applied as the dressing after skin closure. SSIs at 30 days were collected and the Observed to Expected (O/E) ratio was calculated. Statistical analysis was performed using Chi square with p<0.05 as significant. Results: A total of 76 cases were evaluated, 51% (39) clean, 49% (37) CC. Overall, the mean age was 61+/-2 years, and BMI 30.4+/-0.65. 61% male, 40% DM, 12% smokers and 10% AKI. Overall the ACS NSQIP calculated SSI risk was 4.13% with no observed 30-day surgical site infections [Expected=4.13, Observed=0, O/E ratio=0, 95%CI (0,0.73), p=0.032]. Conclusions: The use of Preventogen in patients undergoing surgery resulted in a significant reduction of SSI rates with no observed 30-day SSIs in a patient cohort expected to have a 4% SSI rate. Preventogen liquid Polymer can be safely used as elastomeric see-through dressing in clean and clean contaminated surgical cases to significantly reduce SSI rates.

The amazing world of obligate anaerobic Gram positive cocci: a critical analysis of 598 infectious episodes in the era of MALDI-TOF MS

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Authors:
Aaron George, Hugo Bonatti, Joel Grunhut, Pooja Ajith

Body of Abstract:
Background: Peptostrepotococci have been known as 2nd most common anaerobic bacteria causing diseases in humans. Better microbiology testing systems have allowed for better distinguishing the different species and genus of Gram positive obligate anaerobic cocci (GPAC). The currently accepted classification distinguishes between Peptostreptococcus anaerobius (PA), Finegoldia magna (FM), Parvimonas micra (PM), Peptionphilus asaccharolyticus (PAs) and Anaerococcus prevotii (AP), however, this list is expanding.
Patients and Methods: Our institutional database was searched for all infections caused by GPAC during a 4-year period. Identification was done using biochemical assays during the first 2 years and thereafter, using MALDI-TOF.
Results: In total, 714 isolates of GPAC in 597 patients (52.3% male) were identified. Table 1 shows demographic, clinical and microbiology data for the different GPAC: PA (90), FM (212), PM (74), PAs (125) and AP (146); in 50 cases (8%) two different GPAC were isolated. Median age was 56.5 (range 1 day to 98.8) years including 16 pediatric and 53 octogenarian patients. Median BMI was 30.8 (range 11.5 – 77.5) kg/m2 with a 56% obesity rate; 37% were diabetic and 35% active smokers. Drained abscesses/fluid collections and tissue samples accounted for 84%% of specimens, wound cultures for 5% and blood cultures for 11% of specimens; 57% of GPAC isolates were identified since MALDI-TOF introduction. Infection locations were head/neck 4%, trunk 35%, upper extremity 3%, lower extremity 36%, intraabdominal 11%, chest 1% and blood stream 11%. Microscopy of 530 specimens revealed WBC in 78%, Gram positive cocci in 78%, Gram negative rods in 38% and Gram positive rods in 29%. Normal flora, in addition to GPAC was reported in 54% of specimens. In 25% EC was a single isolate; spectrum of pathogens isolated in addition to GPAC in 446 mixed infections included staphylococci (127), streptococci (103), enterococci (18), Gram negative rods (161), other anaerobes (264), and yeast (10). Treatment consisted of surgical drainage/debridement during which samples for microbiology were taken and antibiotics with anaerobic activity.
Conclusion: GPAC are a diverse group of pathogen and have remained an important cause of serious surgical infections. PM was more commonly found in intraabdominal infections and together with AP had the highest propensity to invade the blood stream. FM on the other hand is most commonly found in soft tissue infections.

Necrotizing Enterocolitis is Associated with Elevated Iron Levels and Toxic Lipid Radicals in Neonatal Intestinal Tissue

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Authors:
Alex Frickenstein, Aslan Massahi, Catherine Hunter, Chase Calkins, Cody Dalton, Grant Gershner, Heather Grubbs

Body of Abstract:
Purpose: Necrotizing enterocolitis (NEC) is a devastating disease that continues to plague neonates in neonatal intensive care units, despite over sixty years of research. Ferroptosis, a recently discovered version of programmed cell death similar to Apoptosis, is characterized by the accumulation of lipid radicals and iron. While Ferroptosis has been illustrated in NEC, but its role has yet to be defined. We hypothesize that patients with active NEC will have higher levels of iron compared to other groups. We also hypothesize that patients with active NEC will have higher levels of the toxic lipid radicals 4-hydroxyl-2-hexenal (4-HHE) and 4-hydroxynonenal (4-HNE), which are seen in oxidative stress.

Methods: For iron analysis, intestinal tissue was collected from control patients, patients with a history of NEC, and patients with active NEC. The tissue underwent acid digestion, and a subsequent colorimetric assay was performed using a bathophenanthroline-based colorimetric assay. Using the same patients, new tissue samples were prepared and analyzed using inductively coupled plasma mass spectrometry (ICP-MS). For lipid radical analysis, enteroids were grown from similar cohorts and underwent NEC induction. These were then harvested, processed, and analyzed using western blotting for 4HHE and 4HNE. Statistical analysis was then performed using One- or Two-way ANOVA and Student’s t-test as appropriate.

Results: Patients with active NEC had significantly elevated levels of iron compared to control (p=0.0029) and those with a history of NEC (p=0.0008). There was no significant difference between control patients and those with a history of NEC (p=0.6699). This pattern was consistent for ICP-MS. Patients with NEC had significantly higher levels of iron compared to control patients (p=0.015). Enteroids who underwent NEC induction had significantly elevated levels of 4-HHE (p=0.0114). While these enteroids had decreased levels of 4-HNE compared to the control, this difference did not reach statistical significance.

Conclusion: Patients with active NEC had significantly higher levels of iron compared to controls and those who had recovered from NEC. This was found true using two different modes of iron level quantification. Additionally, NEC enteroids had significantly elevated levels of 4-HHE. In line with our lab’s previous research, this strongly implies that Ferroptosis plays a role in the pathology of NEC. In line with our lab’s previous research, this strongly implies that Ferroptosis plays a role in the pathology of NEC.

Investigating microbial mitigation for surgical incision sites using UV-C

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Authors:
Benjamin Robertson, Christopher Jones, David Brenner, Deborah Mosca, Eric Prast, Ernest Blatchley III, Karl Linden, Katja Auer, Nancy Havill, Richard Rasansky

Body of Abstract:
Background
Surgical site infections (SSIs) are a serious complication following surgery, requiring additional antibiotics, prolonged hospitalizations, or hospital readmission. The emergence of multidrug-resistant pathogens has diminished the effectiveness of traditional antimicrobials thus requiring a new approach to prevention and treatment. We are developing an innovative device (xIP) that uses UV-C to inactivate pathogens in surgical incision sites, mitigating the risk of developing an SSI.
Irradiation in the UV-C range (200-280 nm) is well known to inactivate pathogens by damaging DNA and RNA. Despite its known effectiveness in surface and aerosol pathogen inactivation, there is a limited body of work for the application of UV-C on surgical sites.

Methods

To assess disinfection in the UV-C range we explored three sources. A Krypton-Chloride Excimer (KrCl*) lamp ( peak = 222 nm), a pulsed Xenon (PX) emitter (broad spectrum), and a UVC LED ( peak = 282 nm). Inactivation of Escherichia coli (E. coli, ATCC 29425) and methicillin-resistant Staphylococcus aureus (MRSA, USA300) was determined by in vitro exposure to UV-C at doses of 0 (control), 2, 5, 10, 15, and 20mJ/cm2.

Microbial suspensions of log-phase cultures were pelletized and resuspended in phosphate buffered saline three times. The adjusted suspension concentration of ~109 CFU/mL was then diluted to 107 CFU/mL. After UV exposure, suspensions were plated on an agar substrate using a grid-based method. After incubating for 48 hours at 37°C, remaining viability was determined.

Results

For all emitters, we observed a 4.5-5+ log reduction in MRSA and 4-5+ log reduction in E. coli at the highest UV dose (20mJ/cm2). PX and KrCl* emitters both showed peak inactivation of 5+ in both test microorganisms, while LED showed 4 and 4.5 log reduction in E. coli and MRSA, respectively. PX demonstrated the highest inactivation efficiency (log-reduction per unit dose), followed by KrCl* and LED.

Conclusions

In-vitro data suggest that surgical sites could be effectively treated in less than a minute with a small hand-held device and less than 10 seconds with a larger device. Inactivation of MRSA using a superficial wound model in hairless SHKI1-elite mice (Charles River strain code 477) is in progress.

In-silico modelling using optical raytracing is in progress to understand the impact of wound and skin micro-environment on the performance of the device. These data will help inform ex-vivo testing using porcine or surrogate human skin (EpiDerm FT) models to evaluate the performance of our device in different wound types such as incisions, abrasions, and punctures as well as the impact of fluids such as saline and blood.

Development of the xIP device is underway in collaboration with healthcare professionals to produce a product that is effective, fits into current practice, and is broadly automated. Upon successful completion of a prototype device, clinical efficacy will be explored.

DUPLICATE SUBMISSION – DO NOT SCORE** Rare in the Air: Disseminated Coccidiomycosis in an Immunocompetent Patient

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Authors:
Nicole Siparsky

Body of Abstract:
Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States, often manifesting as a mild respiratory illness in immunocompetent individuals. Disseminated coccidioidomycosis occurs rarely (1%), typically in immunocompromised patients, involving extrapulmonary sites such as skin/soft tissue, bones, and the central nervous system (CNS). We present an unusual case of disseminated coccidioidomycosis with extensive multi-system involvement in an otherwise healthy young male, complicated by significant psychiatric and treatment adherence challenges.
Methods: We performed a retrospective case review after obtaining expedited Institutional Review Board approval by exemption, including notes, labs, imaging, culture data, and procedural reports.
Results: A 23-year-old male with asthma presented with an 8-month history of generalized pain, weight loss, intermittent chills, and limited ambulation due to right hip pain. Residential history included Arizona and the Great Lakes region with notable prior incarceration in Arizona. Examination revealed tachycardia (HR 120 beats per minute), lethargy, and tender swellings of the right thigh and left buttock. Labs demonstrated anemia (Hgb 7.9 g/dL), leukocytosis (13 × 10³/μL), elevated C reactive protein (165 mg/L), and hypoalbuminemia (2.5 g/dL). Imaging revealed a miliary pattern of pulmonary micronodules, cystic structures in multiple anatomical regions, and destructive bony lesions. Fine needle aspiration of a thigh lesion confirmed Coccidioides immitis. Cerebrospinal fluid sampling revealed WBC 0/uL, glucose 55 mg/dL, protein 28.9 mg/dL, and negative bacterial and fungal cultures. He was initially treated with fluconazole 400 mg daily. Subsequent admissions highlighted complications from poor medication adherence and worsening fungal burden despite increasing the fluconazole dose to 400 mg twice daily. Repeat imaging demonstrated extensive fluid collections and abscesses involving the pelvis, lumbar spine, and femoral regions. Psychiatry also noted psychotic features and cognitive decline, further complicating care. The antifungal regimen escalated to liposomal amphotericin B and voriconazole due to new neurologic involvement and significant disease progression. His course also included surgical drainage of a 22 cm buttock muscle abscess by skip-incision technique with insertion of four long-term surgical loop drains to prevent recurrence, as well as percutaneous drainage of deep space abscesses of the right thigh not amenable to simple drainage.
Conclusion: This case highlights the atypical presentation and challenges in managing disseminated coccidioidomycosis in an immunocompetent patient. Delayed diagnosis, medication nonadherence, and psychiatric comorbidities necessitated a multidisciplinary approach. Effective management required antifungal therapy escalation and surgical interventions. This case emphasizes the importance of early diagnosis and comprehensive care.

Infection: A Major Contributor to Anemia of Critical illness

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Authors:
Conor Dillon, Elizabeth Wang, Harshank Patel, Hassan Nadeem, Monica Patten, Robert Sawyer, Sara Hennessy, Tjasa Hranjec

Body of Abstract:
Background: Critically ill patients often receive transfusions beyond the initial resuscitation (>48 hours), not always associated with hemorrhage or perioperative blood loss. We hypothesized that injured, infected patients would receive fewer products due to their hypercoagulable state.

Methods: A single center, chart review identified all adult, trauma patients, admitted to our trauma Intensive Care Unit (ICU) with hospital length of stay (LOS) ≥7 days over a 12-month period. Infections were divided into early (≤72 hours post-trauma) and late (>72 hours post trauma). Univariate analysis was used to evaluate an association between anemia (hemoglobin ≤ 7.9) outside of the initial resuscitation window (>48 hours), infection, and transfusion. Multivariate analysis identified risk factors for transfusion.

Results: A total of 145 patients were included: mean age 50±1.7 years, mostly male (71%) with mean LOS 14.7±0.9 days. Among 79 (54.5%) injured patients requiring no transfusion during hospitalization, 9 (11.4%) were treated for an infection (Figure 1). Comparatively, 66 patients were transfused beyond 48 hours, with 52 patients (78.8%) infected, p<0.0001. Pneumonia was most frequently diagnosed (70%), followed by intra-abdominal infection (17.3%). Infected patients received a total of 271 RBC transfusions, compared to 28 in non-infected patients, p<0.0001. Patients with early infections received less red blood cells (RBC) compared to late infections (1.3±0.6 vs 5.1±1.0, p=0.0024). Early diagnosis and treatment of infections was associated with less RBC (3.1±0.9 vs 6.0±1.5, p=0.0824). Most episodes of anemia had no identifiable bleeding source, however, 77.5% of infections were diagnosed within 72 hours of the lowest, documented hemoglobin. Nearly one-third of the patients experienced severe bleeding (GI hemorrhage, retroperitoneal hematoma, hemoptysis) and required life-saving interventions. Most (93%) patients with severe bleeding were found to have late or persistent infections that despite treatment and clinical improvement, were not abolished. When adjusted for age and gender, perioperative bleeding (OR 13.8, CI 4.1-46) and infection (OR 37.7, CI 12.5-113.4) were found to be the most significant predictors of transfusion beyond the resuscitation period (c-statistic 0.908). Of note, only patients with late infections developed documented venous thrombosis (n=6). Conclusions: A strong association exists between infection and significant hemorrhage in the ICU. An acute decrease in hemoglobin (anemia of critical illness) without obvious cause may be considered as a trigger for infectious work-up in patients whose clinical signs, symptoms and laboratory/radiologic findings are unclear. Prompt diagnosis and treatment of infection may decrease the risk of severe hemorrhage and volume of transfusions. Figure 1. Venn diagram of patients based on their infection, transfusion or perioperative status

Infections caused by the emerging anaerobic surgical pathogen Finegoldia magna: review of 212 cases

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Authors:
Aaron George, Hugo Bonatti, Joel Grunhut, Jonathan Adams, Junius Rosario, Pooja Ajith

Body of Abstract:
Background: Finegoldia magna (FM), previously referred to as Peptostreptococcus magnus, is a Gram-positive obligate anaerobic coccus (GPAC) that typically reside as part of the normal human skin and mucosal flora. They can act as an opportunistic pathogens being one of the most pathogenic GPAC. Severe infections such as endocarditis, pericarditis, necrotizing pneumonia and less common intraabdominal infections have been reported. FM has a higher propensity to cause soft tissue infections including necrotizing fasciitis.
Patients and Methods: Our institutional database was searched for all cases of FM infections during a 4-year period. Pathogens reported out as Peptostreptococcus magnus prior to introduction of MALDI-TOF in 2021 were reclassified as FM.
Results: A total of 261 isolates of FM in 212 patients (43% male) were identified. Median age was 54.1 (range 2.5 to 97.6) years). FM accounted for 37% of all 714 isolates of GPAC outnumbering Peptostreptococcus anaerobius (15%), Parvimonas micra (12%), Peptoniphilus asaccharolyticus (21%) and Anaerococcus prevotii (25%). For FM patients, rate of obesity was 60%, DM 39% and 34% of patients were active smokers. 93% of isolates were from drained abscesses or fluid collections and tissue biopsies, 4% were from wounds and 3% were recovered from blood cultures. 67% of specimens were sent by surgical services, 6% by medical teams, 11% by primary care and 16% cam from the emergency department. Infections were located at head&neck 3%, trunk 34%, upper extremity 3%, lower extremity 53% intraabdominal 4% with 3% bacteremia cases. Microscopy of 205 specimens revealed WBC in 76%, Gram positive cocci in 77%, Gram negative rods in 26% and Gram positive rods in 20%. In 24% FM was a single isolate, spectrum of pathogens isolated in addition to FM included staphylococci (29%), streptococci (17%), enterococci (3%), Gram negative rods (24%), anaerobes including other GPAC (50%), and yeast (1%). Staphylococcus aureus was the most common single co-infecting pathogens (27%) with 50% being MRSA. Treatment consisted of surgical drainage/debridement and antibiotics including Betalactms or clindamycin; outcome was in general favorable.
Conclusion: FM is an emerging pathogen mainly causing skin and soft tissue infections of the trunk and lower extremity. The exact role of FM in mixed infections is still unclear and warrants additional research.

Risk of CMV Infection and Seroconversion in Kidney Transplantation in adults – an analysis of induction over time.

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Authors:

Body of Abstract:
Background: CMV is one of the most consequential infections affecting kidney transplant recipients, leading to higher risk of graft loss, morbidity and mortality1. There are multiple risk factors for CMV seroconversion including donor/recipient serological status, anti-thymocyte globulin (ATG) induction and mycophenolate maintenance immunosuppression2,3. This study evaluates induction regimens, among other risk factors, over the past two and the half decades.

Methods: UNOS database was analyzed from year 2000 to 2024. Cox regression was used for the occurrence of CMV IgM+ from IgG- or IgG+ (N=206,113). Logistic regression was done for seroconversion analysis (IgM-/IgG- to IgM+/IgG+) (N = 45,783).

Results: Recipient who were older, men, of African American or Hispanic ethnicity/group, with higher cPRA and longer wait listing had higher odds of (primary and secondary) infection and seroconversion due to CMV infection. Alemtuzumab correlated with higher odds of infection but lower seroconversion (HR 1.18 95%CI[1.09-1.26]; p<0.001 and OR 0.89 95%[0.80-0.98]; p=0.027 respectively) than thymoglobulin. Seroconversion was less likely with IL2Ra induction (OR 0.86 95%[0.78-0.95]; p=0.003) and infection less likely with dual induction ATG+IL2 Receptor antagonist (HR 0.72 95%[0.60-0.86]; p<0.001). Seroconversion was less likely for recipients transplant between 2012 and 2024 compared to 2000 until 2011 (OR 0.91 95%[0.84-0.99]; p=0.035). Conclusions: While primary and secondary CMV infections seem to be similar over time, the risk of seroconversion appears to have improved in the past decade, possibly due to the adoption of better prophylaxis regimens. 1- Selvey, L.A., Lim, W.H., Boan, P. et al. Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience. BMC Infect Dis 17, 501 (2017). https://doi.org/10.1186/s12879-017-2599-y 2- Luan FL, Samaniego M, Kommareddi M, Park JM, Ojo AO. Choice of induction regimens on the risk of cytomegalovirus infection in donor-positive and recipient-negative kidney transplant recipients. Transpl Infect Dis. 2010 Dec;12(6):473-9. doi: 10.1111/j.1399-3062.2010.00532.x. PMID: 20576019; PMCID: PMC3831513. 3- Sarmiento JM, Dockrell DH, Schwab TR, Munn SR, Paya CV. Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients. Clin Transplant. 2000 Apr;14(2):136-8. doi: 10.1034/j.1399-0012.2000.140206.x. PMID: 10770418.

Microbial Profile and Antibiotic Sensitivity in Obstructive Jaundice: Insights from a Single-Center Study

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Authors:
Adianto Nugroho, Aditomo Widarso, Anti Dharmayanti, Hana Ayu Shafira, Indah Jamtani, Rofi Y Saunat

Body of Abstract:
Background. Biliary obstruction poses a significant risk of biliary tract infections, warranting prompt and effective antibiotic administration. Empiric antibiotic selection necessitates a comprehensive understanding of the microbial profile. Our study comprehensively describes the microbiology profile of bile culture in biliary obstructive patients.
Methods. A cross-sectional descriptive study was held with data gathered from medical records in our single institution from November 2020 – December 2021 and January – September 2024. Patients’ characteristics, jaundice etiology, bile culture results, and antibiotic resistance were studied.
Results. Among 45 patients that had been analyzed, we found that the most microorganisms found in positive bile culture were gram-negative bacteria, with Escherichia coli and Klebsiella pneumonia being the most found. Two cases had Candida sp. The bacteria were most resistant to penicillin-group antibiotics and most sensitive to carbapenem, amikacin, and tigecycline.
Conclusions. The most prevalent microbes discovered in biliary tract obstruction were gram negative bacteria, with penicillin-group antibiotics being the most resistant antibiotics. Administering the right antibiotics that fit the microorganism profile is critical to prevent antibiotic resistance.

Efficacy of Short vs. Long Course Antibiotics in Treatment of Hinchey 3 and 4 Diverticulitis

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Authors:
Abanoub Awad, Cara Kollwitz, Isaac Theerman, Jason Beckermann, Jennifer Rich, Justin York, Kirstin Kooda, Maria Linnaus, Sara Herrick, Theodore Yang

Body of Abstract:
Background: Antibiotic therapy plays a critical role in the post-operative management of complicated diverticulitis. Traditionally, treatment has involved antibiotics until signs of infection subside, typically spanning 7-14 days. Recent studies, including the STOP-IT trial and national guidelines, support short-course antibiotics once definitive source control has been obtained. Shorter courses are favored to reduce costs and adverse effects associated with prolonged use. In addition, short-course antibiotic regimen supports antibiotic stewardship objectives. We observed variation in clinical practice for patients with extensive intra-abdominal infections such as Hinchey 3 and 4 diverticulitis and sought to evaluate outcomes in this population.
Methods: Retrospective chart review was performed of all adults (>18 years old) patients who underwent a sigmoid colectomy with stoma secondary to Hinchey class 3 and 4 diverticulitis at a large hospital system across several states from January 1st, 2018, to December 31st, 2023. Patients were divided into two groups: those with short-course antibiotics (SAC group) (≤5 days) and those with long-course antibiotics (LAC group) (>5 days).
The primary outcome was composite superficial surgical-site, incisional, organ space infection or death within 30 days after the procedure.
Results: A total of 133 met inclusion across 4 major hospital sites; 51.1% were male. Most common comorbid condition among all patients was HTN (53%) while most common ASA scores were ASA 3, ASA 2 and ASA 4 (57.1%, 21.1% and 20.3%, respectively). LAC group patients had higher ASA scores (p=0.001), higher incidence of acute kidney injury on admission (p=0.0135) and had higher rates of immune compromise (p=0.0002) than SAC group patients. Composite rates of 30-day mortality, superficial, incisional and organ space infections occurred 8 of 53 patients (15.1%) in SAC group and 27 of 80 patients (33.8%) in LAC group, (p=0.02601), When broken down by SSI type, there were similar rates of superficial, deep incisional and organ space infection between the groups. Mortality rate was higher in LAC group (10% vs 0%, p = 0.0213).

Conclusion: Longer antibiotic therapy for Hinchey 3-4 diverticulitis does not improve composite mortality, SSI, and organ space infection in patients undergoing sigmoidectomy and stoma. In our practice patients with higher ASA scores, immunocompromised state, and acute kidney injury were more likely to receive a longer course of antibiotics. Mortality rates were higher in longer antibiotic therapy group potentially indicating severity of illness and aggressive treatment to prevent a negative outcome.