Vacuum-assisted closure device in intensive care unit patients and dissemination of Gram-negative bacteria

摘要

We read with interest the study by Batacchi and colleagues in a recent issue of Critical Care []. Vacuum-assisted closure (VAC) decompression is promising for the management of open abdomen, but our limited experience with this system suggests that dissemination of bacteria may occur.Recently, two patients were treated with VAC in our intensive care unit (ICU). Patient 1 was a 62-year-old man who was originally operated on for paraganglioma and underwent left nephrectomy and gastrojejunal anastomosis. Patient 2 was a 54-year-old woman who was admitted to the ICU two months after a complicated laparoscopic sleeve gastrectomy for morbid obesity. In both patients, at a certain point during their course, intra-abdominal sepsis developed, and they were both managed with extensive debridement, drainage, and VAC placement. Both patients developed fistulas, and although dressings and VAC pump containers were meticulously changed, leaks were repeatedly observed around the dressings.Furthermore, 2 to 4 weeks after the placement of VAC, a rise of positive cultures for Gram-negative bacteria was observed in all patients in our ICU (Figure ). As depicted in Figure , Klebsiella pneumoniae species became prevalent in our flora despite barrier measures and the isolation of both patients in a separate ward. In 12 out of 34 cases, KPC K. pneumoniae was isolated, whereas in one case it was resistant to all antibiotics.>Number of positive Gram-negative and Gram-positive cultures in our intensive care unit during the stay of patients 1 (left) and 2 (right). The arrows represent the time of vacuum-assisted closure placement for each patient.