Timing and Type of Bacteria In Surgical Site Infections Following Complex Abdominal Wall Reconstruction.

PURPOSE: The goal of this study was to assess the bacteriology of surgical site infections (SSIs) in patients undergoing complex abdominal wall reconstruction (CAWR) with biologic mesh.

METHODS

This was a prospective cohort study of all patients who developed SSI following CAWR with biologic mesh between 2017-2020 at an academic tertiary/quaternary care center. The patients were subdivided into six overlapping groups: infections found during hospitalization vs. infections found after discharge, sensitive bacteria vs. resistant bacteria, and nosocomial bacteria vs. intestinal bacteria.

RESULTS

Of the 194 patients who underwent CAWR during the study period, 33 (17%) developed SSI. SSI was more commonly discovered after discharge than during hospitalization. These SSIs were vancomycin-resistant Enterococcus (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) rather than sensitive bacteria, and required re-operation, which were more frequently found following elective procedures. VRE and MRSA infections were more common with clean wounds than with clean/contaminated, contaminated, or dirty wounds, while SSIs with intestinal flora were more common following fistula and stoma takedown.

CONCLUSIONS

Surgical site infections with resistant bacteria manifest more frequently post-discharge and require more re-admissions and re-operations.