Surgical site infection after penetrating abdominal trauma with bowel involvement: a comparison between HIV-seropositive and seronegative patients

Abstract

Background: The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and  therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-  seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication.

Methods: 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included  in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep  SSI incidence rates were evaluated.

Results: Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No  significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61%  vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250  cells/µl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis.

Conclusion: HIV-infection is not an independent  risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin,  relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered  in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative  pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.