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Effects of prolonged stay in hospital on gastric flora
D Voros1, A Datsis, S Demeridou
12nd Department of Surgery, University of Athens, Aretaeion Hospital, Greece.
Objective:
To find out if a long preoperative stay in hospital results in the introduction of micro-organisms into the gastric flora that are resistant to the usual perioperative chemoprophylaxis.
Design:
Observational study.
Setting:
Teaching hospital, Greece.
Subjects:
145 consecutive patients admitted for abdominal or pelvic operations.
Interventions:
Aspiration of gastric fluid for measurement of pH and culture.
Main Outcome Measures:
Growth and type of pathogens in gastric aspirate.
Results:
125 patients spent a mean (range) of 13.6 days (7-69) in hospital preoperatively and 20 patients spent 3.1 (1-7) days. In the long-stay group 103 had a gastric pH of <4 and in 22 it was 4 or more; in 40 patients pathogens were grown from the gastric aspirate but resistant Pseudomonas cepacia was grown from only 2. In the short-stay group 16 patients had a pH of <4 and in 4 it was 4 or more; in 4 patients pathogens were grown from the aspirate.
Conclusion:
Prolonged stay in hospital preoperatively does not seem to affect the gastric flora, so routine chemoprophylaxis should be sufficient in abdominal operations.
Insights
A long preoperative hospital stay did not significantly alter gastric flora or increase antibiotic-resistant organisms. Routine perioperative chemoprophylaxis is likely sufficient for abdominal operations, even with extended pre-surgery hospitalizations.
Area of Science:
- Medical Microbiology
- Surgical Infectious Diseases
- Hospital Epidemiology
Background:
- Preoperative hospital stays can potentially alter patient microflora.
- The impact of prolonged preoperative hospitalization on gastric flora and antibiotic resistance is not well-established.
- Understanding gastric flora changes is crucial for effective perioperative chemoprophylaxis.
Purpose of the Study:
- To investigate whether extended preoperative hospital stays introduce antibiotic-resistant microorganisms into gastric flora.
- To determine if prolonged hospitalization impacts the effectiveness of standard perioperative chemoprophylaxis for abdominal operations.
Main Methods:
- Observational study conducted in a Greek teaching hospital.
- Gastric fluid aspiration and culture performed on 145 patients undergoing abdominal or pelvic surgery.
- Patients were categorized into long-stay (mean 13.6 days) and short-stay (mean 3.1 days) preoperative groups.
Main Results:
- No significant difference in the prevalence of resistant pathogens, including *Pseudomonas cepacia*, was found between long-stay and short-stay patient groups.
- Pathogens were identified in gastric aspirates of 40 patients in the long-stay group and 4 patients in the short-stay group.
- Gastric pH levels did not show a clear correlation with the length of preoperative stay or the presence of pathogens.
Conclusions:
- Prolonged preoperative hospital stays do not appear to adversely affect gastric flora in a manner that compromises perioperative chemoprophylaxis.
- Routine chemoprophylaxis is considered sufficient for patients undergoing abdominal operations, regardless of preoperative hospital duration.
- Further research could explore specific patient factors influencing gastric colonization during hospitalization.