Abdominal fascia dehiscence: is there a connection to a special microbial spectrum?
P V Stropnicky1, F Kandemir2,3, M Schäffer2
1Clinic for General, Visceral, Thoracic, Paediatric and Transplant Surgery, University Hospital Schleswig-Holstein, Arnold-Hellerstr. 3 Campus Kiel, 24105, Kiel, Germany. PernillaVirginia.Stropnicky@uksh.de.
Introduction:
Acute fascia dehiscence (FD) is a threatening complication occurring in 0.4-3.5% of cases after abdominal surgery. Prolonged hospital stay, increased mortality and increased rate of incisional hernias could be following consequences. Several risk factors are controversially discussed. Even though surgical infection is a known, indisputable risk factor, it is still not proven if a special spectrum of pathogens is responsible. In this study, we investigated if a specific spectrum of microbial pathogens is associated with FD.
Methods:
We performed a retrospective matched pair analysis of 53 consecutive patients with an FD after abdominal surgery in 2010-2016. Matching criteria were gender, age, primary procedure and surgeon. The primary endpoint was the frequency of pathogens detected intraoperatively, the secondary endpoint was the occurrence of risk factors in patients with (FD) and without (nFD) FD.
Results:
Intraabdominal pathogens were detected more often in the FD group (p = 0.039), with a higher number of Gram-positive pathogens. Enterococci were the most common pathogen (p = 0.002), not covered in 73% (FD group) compared to 22% (nFD group) by the given antibiotic therapy. Multivariable analysis showed detection of Gram-positive pathogens, detection of enterococci in primary laparotomy beside chronic lung disease, surgical site infections and continuous steroid therapy as independent risk factors.
Conclusion:
Risk factors are factors that reduce wound healing or increase intra-abdominal pressure. Furthermore detection of Gram-positive pathogens especially enterococci was detected as an independent risk factor and its empirical coverage could be advantageous for high-risk patients.
Insights
Fascia dehiscence (FD) after abdominal surgery is linked to specific pathogens. Enterococci were frequently detected and inadequately covered by antibiotics, highlighting them as a key risk factor for FD.
Area of Science:
- Abdominal surgery complications
- Surgical site infections
- Microbial pathogenesis
Background:
- Fascia dehiscence (FD) is a serious complication after abdominal surgery, associated with increased morbidity and mortality.
- While surgical infection is a known risk factor, the specific microbial pathogens involved in FD remain unclear.
- Understanding pathogen spectrum is crucial for improving patient outcomes and preventing incisional hernias.
Purpose of the Study:
- To investigate the association between specific microbial pathogens and acute fascia dehiscence (FD) following abdominal surgery.
- To identify key pathogens contributing to FD and their correlation with risk factors.
- To inform targeted antibiotic strategies for high-risk surgical patients.
Main Methods:
- Retrospective matched-pair analysis of 53 patients with FD and controls (nFD) after abdominal surgery (2010-2016).
- Matching criteria included gender, age, primary procedure, and surgeon.
- Primary endpoint: frequency of intraoperatively detected pathogens; Secondary endpoint: risk factor occurrence in FD vs. nFD groups.
Main Results:
- Intra-abdominal pathogens were significantly more frequent in the FD group (p=0.039), with a higher prevalence of Gram-positive pathogens.
- Enterococci were the most common pathogen (p=0.002) and were inadequately covered by empirical antibiotic therapy in 73% of FD cases versus 22% in the nFD group.
- Multivariable analysis identified Gram-positive pathogens, enterococci, chronic lung disease, surgical site infections, and steroid therapy as independent risk factors for FD.
Conclusions:
- Detection of Gram-positive pathogens, particularly enterococci, is an independent risk factor for fascia dehiscence after abdominal surgery.
- Inadequate empirical antibiotic coverage for enterococci in high-risk patients may contribute to FD development.
- Targeted antibiotic strategies considering enterococci may be beneficial for preventing FD in at-risk populations.
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