Several studies have investigated open abdomen in the context of intra-abdominal infections, generating great interest and optimism in the medical community [206–209]. However, in 2007 a randomized study compared open and closed “on-demand” management of severe peritonitis. The study was terminated following the inclusion of only 40 patients after acknowledging the clearly discernable clinical disadvantages of the open abdomen group (55% and 30% mortality rates for open and closed procedures, respectively). It should be noted that, in this study, the Crenolanib mouse open abdomen was managed exclusively with non-absorbable polypropylene mesh and without negative pressure
therapy . Following stabilization of the patient, surgeons should attempt early, definitive closure of the abdomen. Primary fascial closure may be possible when there is minimal risk PF-02341066 price of excessive tension or recurrence of IAH (Recommendation 1C). When early, definitive fascial closure is not possible, progressive closure should be attempted each time the patient returns for subsequent procedures. For patients with persistent large fascial defects, it is suggested that surgeons implement bridging
with biological materials (Recommendation 1C). Following stabilization of the patient, the primary objective is early and definitive closure of the abdomen to minimize complications associated with OA . For many patients, primary fascial closure may be possible within a few days of the initial operation . In other patients, early definitive fascial closure may not be possible. In these cases, surgeons should attempt progressive closure, in which the abdomen is incrimentally closed each time the patient undergoes
a subsequent surgery. Many methods of fascial closure have been described in medical literature [211–216]. In many cases abdominal closure is only partially achieved, almost resulting in large, debilitating hernias of the abdominal wall that will eventually require complex surgical repair. In these cases, bridging with biological mesh is recommended . Antimicrobial therapy Initial antibiotic therapy for IAIs is typically empirical in nature because the patient needs immediate attention, and microbiological data (culture and susceptibility results) can require up to 48 hours before they are available for a more selleck inhibitor detailed analysis. IAIs can be treated with either single or multiple antimicrobial regimens depending on the range requirements of antimicrobial coverage. Beta-lactam/beta-lactamase inhibitor combinations exhibit in vitro activity against gram-positive, gram-negative, and anaerobic organisms [218, 219] and are viable options for empirical treatment of IAIs .