Prevalence and source control of intraabdominal infection A single Indonesian hospital perspective

Author(s):
Diane Catalano; Toar Lalisang

Background:

Intraabdominal infection (IAI) and complicated IAI (cIAI) remains a problem of surgical practice in our hospital. Such problem found to be different with those reported, predominately with delayed in management, both of prehospitally and in hospital due to many reasons; referred to difficult cases. A descriptive study run to find out the prevalence and output of source control  management as the baseline to set a guideline for quality improvement.

Methods:

Data of those with IAI of different etiology were collected during year 2017. Prevalence, etiology, epidemiology and outcome were noted and subjected to analysis descriptively.

Results:

There were 945 abdominal surgeries managed during 2017. Out of these 110 (11.74%) were found to be IAI and cIAI; 74 (66.66%) were males and 36 (32.44%) were females. Median age was 48.5 years old (18–81). The predominant pathology was perforated gastroduodenal ulcer (13.5%), colonic perforation due to different etiology (10.8%), perforated appendicitis (8.1%), perforated ileum (5%) and perforated cholecystitis (5%). The remains were anastomosis leaks, trauma, etc. There were no comorbid noted but a case with hypertension. Surgical drainage preceded in 4 subjects (3.6%), surgical debridement in 14 subjects (12.6%), and the remains were preceded definitive source control including stoma (83.8%). Steps surgery intervention( surrogate surgery)  were the strategy to  overcome the abdominal sepsis cases.   The epidemiology noted of most was Escherichia coli and Klebsiella penumoniae. The mostly used antibiotic was amikacin sulphate in combination with metronidazole. Mortality was noted in 20 subjects (18%). Re-laparotomy  were performed on 19 cases and 5 cases ended as operative mortality.

Conclusions:

Prevalence of IAI in our hospital was 11.74% and op mortality was high. Definitive source control as surgeon’s preference remain the most intervention preceded. Surrogate surgery most were be chosen during source control procedure