Program and AbstractsThirty-fifth Annual Meeting of the Surgical Infection SocietyWestlake Village, CaliforniaApril 15–18, 2015
2015; Mary Ann Liebert, Inc.; Volume: 16; Issue: S1 Linguagem: Inglês
10.1089/sur.2015.9981.abstracts
ISSN1557-8674
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoSurgical InfectionsVol. 16, No. S1 AbstractsFree AccessProgram and AbstractsThirty-fifth Annual Meeting of the Surgical Infection SocietyWestlake Village, CaliforniaApril 15–18, 2015Published Online:1 Apr 2015https://doi.org/10.1089/sur.2015.9981.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Accreditation StatementThis activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Surgeons and the Surgical Infection Society. The American College Surgeons is accredited by the ACCME to provide continuing medical education for physicians.AMA PRA Category 1 Credits™The American College of Surgeons designates this live activity for a maximum of 21 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Disclosure Information ParagraphIn compliance with ACCME Accreditation Criteria, the American College of Surgeons, as the accredited provider of this activity, must ensure that anyone in a position to control the content of the educational activity has disclosed all relevant financial relationships with any commercial interest. All reported conflicts are managed by a designated official to ensure a bias-free presentation. Please see the insert to this program for the complete disclosure list.Learning Objective:This activity is designed for physicians, research scientists, nurses, nurse practitioners, and pharmacists.Learning Objective(s)–At the end of this activity, participants will be able to: Summarize results on the latest research relevant to the diagnosis and treatment of surgical infectionsUse antimicrobials for empiric treatment of sepsis in trauma patientsDebate current controversies in the diagnosis and treatment of surgical infectionsUse antimicrobials for a set course in the treatment of surgical infectionsDiscuss recent developments in the study of cellular and molecular mechanisms in the pathogenesis of surgical infectionsUnderstand current treatment for secondary bacterial peritonitisAmerican College of Surgeons, Division of EducationProgramWednesday, April 15, 201519:00–21:30Presidential Dinner (By invitation)Pagoda LawnThursday, April 16, 201506:30–07:30BreakfastGarden Lawn07:00–07:30Executive Council Breakfast (By invitation)Georgian07:30–11:30Executive Council Meeting (By invitation)Georgian07:30–11:30SURGICAL INFECTION UPDATE SYMPOSIUMBallroom BIOLOGY OF SEPSIS and PHARMACOLOGY 07:30–07:45Microbiology of surgical pathogens: Gram‐positive cocciLena Napolitano07:45–08:00Biology and metabolism of sepsisMatthew Rosengart08:00–08:15Organ physiology and multiple organ failure/dysfunctionJohn Marshall08:15–08:30Antimicrobials and antibiotic PDs: Anti‐staphylococcal drugsPamela Lipsett08:30–09:45Q and A session RISK PREVENTION/PROPHYLAXIS 08:45–09:05New intra‐abdominal infection guidelinesJohn Mazuski09:00–09:15Clostridium difficile infectionsBrian Zuckerbraun09:15–09:30Antibiotic stewardshipRobert Sawyer09:30–09:45Q and A session 09:45–10:00BREAK SPECIFIC INFECTIONS 10:00–10:15Necrotizing soft tissue infectionsAddison May10:15–10:35DEBATE: Acute cholecystitis: Operate? Drain percutaneously? Soumitra Eachempati vs. Saman Arbabi 10:35–10:55DEBATE: Acute diverticulitis: Lavage or resect? Anastomose or divert? Lillian Kao vs. Christine Cocanour 10:55–11:15DEBATE: Acute appendicitis: Antibiotics or appendectomy? Therese Duane vs. E. Patchen Dellinger 11:15–11:30Q and A session 11:30–11:45Nominating Committee (By invitation)Georgian12:00–13:00LUNCHEON SYMPOSIUMGarden Lawn (Industry‐sponsored; not part of scientific program) 13:00–16:45PLENARY SYMPOSIUMBallroom The Art and Science of Surgical Infections (Papers 1–10) Moderators: Nicholas Namias, MD, MBA, and John C. Alverdy, MD O1. Pathway Analysis of the Intestinal Transcriptome of Mice Rescued from Sepsis via a Fecal Microbiota Transplant Demonstrates a Role for IL22.Monika Krezalek (Resident), presenting. University of Chicago. Discussant: Michaela West, MD, PhDO2. Statewide Evaluation of Intra‐wound Antibiotics in Spine Surgery Patients: A Report from the SCOAP‐CERTAIN Collaborative. Anne Pugel, (Resident) presenting. University of Washington. Discussant: Robert G. Sawyer, MDO3. Microbial Changes in Opioid‐Induced Colonic Anastomotic Leak. Baddr Shakhsheer (Resident), presenting. University of Chicago. Discussant: Philip S. Barie, MD, MBAO4. Colonic Lavage for the Treatment of Severe C. difficile Infections: The London Protocol. Kalvin Lung, (Resident) presenting. University of Western Ontario. Discussant: Pamela A. Lipsett, MD, MHPEO5. Hepatocytes Are a Dominant Source Of HMGB1 in the Innate Immune Response During Sepsis. Meihong Deng, (New Member) presenting. University of Pittsburgh. Discussant: Henri R. Ford, MD, MHAO6. Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra‐Abdominal Infection. Zachary Dietch (Resident), presenting. University of Virginia. Discussant: E. Patchen Dellinger, MDO7. Deficiency in Oncostatin M Receptor Results in Improved Survival in Older Mice Following Sepsis Through Down‐Regulation of IL‐10. Saad Salim (New Member), presenting. University of Alberta. Discussant: Brian Zuckerbraun, MDO8. Novel Predictors of Burn Wound Infections in Severely Burned Children. Arham Ali (Resident), presenting. University of Texas Medical Branch. Discussant: Basil A. Pruitt, Jr., MDO9. Repair of the Enteric Nervous System through Vagal‐Mediated Expansion of Neural Stem Cells. Simone Langness (Resident), presenting. University of California, San Diego. Discussant: William G. Cheadle, MDO10. Risk‐Adjustment for Determining Surgical Site Infection in Colon Surgery: Are We Using Appropriate Variables? Sydne Muratore, presenting. University of Minnesota. Discussant: Donald E. Fry, MD16:45–17:30SIS Antibiotic Duration Study‐Robert G. Sawyer, MDLibrary16:45–17:30Committee MeetingsGarden Lawn17:30–18:15Surgical InfectionsEditorial Reception (By Invitation)Balcony B18:15–19:00SIS Foundation Board Meeting(By Invitation)Library19:00–20:30Welcome ReceptionWaterfallFriday, April 17, 201506:30–08:00BreakfastGarden Lawn07:00–08:00Breakfast SymposiumGarden Lawn (Industry‐sponsored; not part of scientific program) 08:00–09:45PARALLEL SESSION IBallroom BCD Clinical Research (Papers 11–15) Moderators: Daithi S. Heffernan, MD, and Sandra Swoboda, RN, MSN O11. RibScore: A Novel Radiographic Score Based on Fracture Pattern that Predicts Pneumonia, Respiratory Failure, and Tracheostomy. Brandon Chapman (Resident), presenting. University of Colorado‐Denver. Discussant: Addison K. May, MDO12. Top Guns: The Maverick and Goose of Empiric Therapy. Stephen Davies (Resident), presenting. University of Pittsburgh. Discussant: Jeffrey L. Johnson, MDO13. Contact Isolation in Trauma Patients: An Analysis of Infectious Complications. Mark Hamill, presenting. University of Virginia. Discussant: Sandra M. Swoboda, MSN, RNO14. Comparing Readmissions and Infectious Complications of Blunt Splenic Injuries Using a Statewide Database. Olubode Olufajo presenting. Brigham and Women's Hospital. Discussant: Daithi S. Heffernan, MDO15. Impact of Type of Insurance on Infection Rates after Trauma. Jaswin Sawhney (Resident), presenting. Brown University.Discussant: Amy A. McDonald, MD08:00–9:45PARALLEL SESSION IIBallroom AE Basic Science (Papers 16–20) Moderators: Carl Hauser, MD and Brian Eliceiri, PhD O16. Hypothermia Prolongs the Survival of Rats with Severe Septic Shock by Inhibiting the Splenic Release of Neutrophils and Monocytes. Rhett N. Willis (Resident), presenting. University of Virginia. Discussant: Kevin P. Mollen, MDO17.Listeria monocytogenes Inhibits Th17 Responses Through TLR2 Signaling. Song Liu, presenting. Medical School of Nanjing University. Discussant: Meihong Deng, MDO18. Mitochondrial ROS Induces Cardiac Inflammation via Damage in Mitochondrial DNA and Stimulation of RAGE Pathway in a Pneumonia‐related Sepsis Model. Qun (Sophia) Zang, presenting. University of Texas‐ Southwestern. Discussant: Carl Hauser, MDO19. Blue Light Reduces Organ Injury During Critical Illness. Du Yuan (Resident), presenting. University of Pittsburgh. Discussant: Nicholas Namias, MD, MBAO20. The Collagenolytic Activity of Fecal Enterococcus faecalis Predicts Anastomotic Leak: Development of a Novel Assay to Clinically Track the Collagenolytic Phenotype. Kristina Guyton (Resident), presenting. University of Chicago. Discussant: Matthew R. Rosengart, MD, MPH09:45–10:00BREAK‐Visit the Exhibits 10:00–11:00William A. Altemeier Memorial LectureBallroom BCD “Evolving Epidemiology of MOF into PICS” Frederick A. Moore, MD, FACS, MCCM Professor and Chief of Acute Care Surgery, University of Florida Health 11:00–12:00Surgical Infection Society Presidential AddressBallroom BCD “Let's Go Far” John C. Alverdy, MD The Sara and Harold Lincoln Thompson Professor and Executive Vice Chair Department of Surgery, University of Chicago Medicine 12:00–13:15LUNCHEON SYMPOSIUMGarden Lawn (Industry‐sponsored;not part of scientific program) 13:30–15:15UPDATE SYMPOSIUM IBallroom BCD International Topics in Surgical Infections Moderator: Joseph Solomkin, MD Topic 1: Strategies to Prevent SSI in JapanKeita MorikaneTopic 2: Approach to Surgical Site Infection in NicaraguaAndrew StephenTopic 3: Surgical Infections in the Deployed SettingDavid BlakeTopic 4: Surgical Site Infection Rates following Cesarean Section in Sub‐SaharanJoseph Solomkin Africa: A Focus Point for Guideline‐Based Intervention 15:15–13:30Break‐Visit the Exhibits 15:30–17:00PARALLEL SESSION IIIBallroom BCD Clinical Research (Papers 21–26) Moderators: Samir S. Awad, MD and Heather L. Evans, MD, MS O21. Preoperative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction. Alison Smith (Resident), presenting. Tulane University. Discussant: Jared Huston, MDO22. Necrotizing Enterocolitis: Does Perforation Matter? Varun Bhalla, presenting. Children's National Medical Center. Discussant: Catherine J. Hunter, MDO23. Abdominal Compartment Syndrome, Cerebral Infarction, and Acute Respiratory Distress Syndrome Are the Biggest Modifiable Risk Factors for Surgical Site Infections in Blunt Traumatic Hemorrhagic Shock. John Hwabejire (Resident), presenting. Howard University. Discussant: Lena M. Napolitano, MDO24. Do Polymicrobial Intra‐Abdominal Infections Have Worse Outcomes than Monomicrobial Intra‐Abdominal Infections? Puja M. Shah (Resident), presenting. University of Virginia. Discussant: Lillian Kao, MDO25. The Influence of Beta‐Lactam Prescribing Patterns on Resistance Rates among Various Adult ICU Populations. Sara E Parli, presenting. University of Kentucky. Discussant: Jeffrey M. Tessier, MDO26. Prophylactic Gentamicin Is Not Associated with Acute Kidney Injury in Patients with Open Fractures. Jeffrey M. Tessier, presenting. JPS Health Network. Discussant: Heather L. Evans, MD, MS15:30–17:00PARALLEL SESSION IVBallroom AE Basic Science (Papers 27–32) Moderators: Matthew R. Rosengart, MD, MPH and Todd W. Costantini, MD O27. Paucity of Bacteria Implicated in Pathogenesis of Experimental Necrotizing Enterocolitis. Joanna Lim (Resident), presenting. Children's Hospital Los Angeles. Discussant: Michael J. Morowitz, MDO28. Pre‐B Cell Colony Enhancing Factor (PBEF)/Nampt Phosphorylation by PI3 Kinase Is Indispensable for the Inhibition of Neutrophil (PMN) Apoptosis in Patients with Sepsis. Song Jia (New Member), presenting. Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto. Discussant: John Mazuski, MD, PhDO29. Acute Appendicitis in Children is Associated with an Abundance of Bacteria from the Genus Fusobacterium. Matthew Rogers (New Member), presenting. Children's Hospital of Pittsburgh. Discussant: Jose J. Diaz, MDO30. Effect of Remote Ischemic Preconditioning on LPS‐Induced Pulmonary Inflammation in Mice. So Jung Choi (New Member), presenting. University of Toronto. Discussant: Brian Eliceiri, PhDO31. Latent Cytomegalovirus Infection Predisposes Immune Competent Hosts to Pro‐Inflammatory Pulmonary Immune Responses. Varun Dwivedi, presenting. The Ohio State University. Discussant: Ori Rotstein, MDO32. Defining the Mitochondrial DAMP Repertoire: Formyl Peptides Are Not All Created Equal! Carl Hauser, presenting. Center for Vascular Biology Research, Harvard Medical School, BI Deaconess Medical Center. Discussant: Gary C. An, MD17:00–18:00Annual Business Meeting(Members only)Ballroom AE18:00Free Evening Saturday, April 18, 201507:00–08:00Executive Council Meeting(By invitation)Georgian07:00–08:00BreakfastGarden Lawn08:00–09:00UPDATE SYMPOSIUM IIBallroom BCD What to Do with the Darned Sub‐specialists: Common Practices in Surgical Infections Moderator: Jeffrey Claridge, MD Topic 1: Thoracic SurgeryDaniel RaymondTopic 2: Orthopedic SurgeryAntonia Chen09:00–10:00UPDATE SYMPOSIUM IIIBallroom BCD PRO‐CON DEBATES Moderator: John Mazuski, MD, PhD DEBATE: Nutritional Support: Does It Matter? Patricia Byers vs. Michael Morowitz DEBATE: Fever‐Suppress or Let It Ride? Carl Schulman vs. Kaysie Banton 10:00–10:15FELLOWSHIP AWARD RECIPIENT PRESENTATIONSBallroom BCD Moderators: Philip S. Barie, MD, MBA and Kevin P. Mollen, MD SIS Foundation Basic or Translational Research Training Fellowship‐2014 Anthony J. Lewis, MD. University of Pittsburgh SIS Foundation Clinical Research Training Fellowship‐2014 Elinore J. Kaufman, MD. Weill Medical College of Cornell University SIS Foundation Junior Faculty Fellowship‐2014–2015 Heather L. Evans, MD, MS. University of Washington10:15–10:30BREAK–Visit the Exhibits 10:30–12:00PARALLEL SESSION V Clinical Research (Papers 33–38)Ballroom BCD Moderators: Mary R. Kwaan, MD, MPH and David P. Blake, MD, MPH O33. Does Circadian Rhythm Affect the Risk for Post‐Operative Infectious Complications? Christopher Guidry (Resident), presenting. University of Virginia. Discussant: Christine S. Cocanour, MDO34. WITHDRAWNO35. Obesity Paradox in Patients with Soft Tissue Infections Nationwide. Elissa Lin, presenting. Brigham and Women's Hospital. Discussant: David P. Blake, MD, MPHO36. Developing an SSI Risk Score Incorporating Daily Objective Wound Assessments Using Machine Learning. Heather L. Evans, presenting. University of Washington. Discussant: Donald E. Fry, MDO37. Component Separation versus Bridged Repair for Large Ventral Hernias: A Multi‐Institutional Risk‐Adjusted Comparison. Julie Holihan (Resident), presenting. University of Texas Health Science Center at Houston. Discussant: Kamal M. F. Itani, MDO38. Clinical Diagnosis of Infection in SICU: You Are Not as Good as You Think! Madhu Subramanian (New Member), presenting. University of Texas, Southwestern. Discussant: Patrick J. O'Neill, PhD, MD10:30–12:00PARALLEL SESSION VI Basic Science(Papers 39–43)Ballroom AE Moderators: Gary C. An, MD and Rachel Khadaroo, MD, PhD O39. Characterization of the Murine Septic Response Using Wireless Telemetry Technology. Anthony Lewis (Resident), presenting. University of Pittsburgh. Discussant: Tina S. Mele, MDO40.Lactobacillus Probiotic Species Strengthen Intestinal Barrier Function and Tight Junction Integrity. Brian Blackwood (Resident), presenting. Northwestern University Feinberg School of Medicine. Discussant: John Marshall, MDO41. Mesenchymal Stem Cells Reverse Anemia and Bone Marrow Dysfunction Following Trauma, Hemorrhagic Shock, and Chronic Stress. Amy Gore (Resident), presenting. Rutgers‐New Jersey Medical School. Discussant: Todd W. Costantini, MDO42. Remote Ischemic Preconditioning Plasma Prevents Neutrophil Infiltration by Increased Anti‐oxidative Capacity in the Zebrafish. Chung Ho Leung, presenting. University of Toronto. Discussant: Brian Zuckerbraun, MDO43.Pseudomonas aeruginosa Infection Augments Burn‐Induced Hepatic ER Stress. Mile Stanojčić (Resident), presenting. Sunnybrook Research Institute, University of Toronto, Toronto, Canada. Discussant: Steven E. Wolf, MD12:00–13:15LUNCHEON SYMPOSIUMGarden Lawn (Industry‐sponsored;not part of scientific program) 13:30–15:00PARALLEL SESSION VII: The Surgical Infection Society‐Supreme Court (Papers 44–48) Ballroom BCD Moderators: Pamela A. Lipsett, MD, MHE, John C. Alverdy, MD, John C. Marshall, MD, Robert G. Sawyer, MD, and William G. Cheadle, MD O44. Computed Tomography Versus Ultrasound for the Diagnosis of Acute Cholecystitis. D. Dante Yeh, presenting. Harvard Medical School, Massachusetts General Hospital.O45. Comparison of Screening Tools' Ability to Detect Sepsis Accurately. Richard Wawrose, presenting. University of Texas Health Science Center at Houston.O46. Pulmonary Microbiome and Cytokine Analysis of Bronchoalveloar Lavage in Mechanically Ventilated Trauma Patients? Ryan M. Huebinger, presenting. University of Texas Southwestern.O47. The Transition from a Rural to Urban Environment in Africa Alters the Expression of Genes Involved in Cholesterol Metabolism: Potential Implications for Susceptibility to Infectious Diseases. Radhames Lizardo, presenting. University of California, San Diego.O48. Impact and Progression of Organ Dysfunction in Patients with Necrotizing Soft Tissue Infections; A Multicenter Study. Eileen M. Bulger, presenting. University of Washington.16:00–17:20POSTER SESSION (Posters 1–52)Ballroom Foyer Basic and Clinical Studies in Surgical Infection Moderators:Group 1: Cell Biology 1 (P1–P6) Michael Cripps, MD and Catherine J. Hunter, MD Group 2: Cell Biology II (P7–P11) Kevin P. Mollen, MD and Celeste C. Finnerty, PhD Group 3: Outcomes I (P12–P17) Patrick J. O'Neill, PhD, MD and Michael K. Liang, MD Group 4: Outcomes II (P18–P23) Soumitra R. Eachempati, MD and Charles A. Adams Jr., MD Group 5: Pathogens I(P24–P29) Jeffrey W. Shupp, MD and Barbara Trautner, MD, PhD Group 6: Pathogens II (P30–P35) Howard Belzberg, MD and Philip Chang, MD Group 7: Wounds and Incisions I (P36–P40) Christine S. Cocanour, MD and Jose J. Diaz, MD Group 8: Wounds and Incisions II (P41–P45) Weidun AlanGuo, MD and Kamal M. F. Itani, MD 19:00–19:45New Member ReceptionBallroom Foyer19:45–22:00Awards BanquetBallroom22:00ADJOURNMENT Oral Presentation AbstractsO01. PATHWAY ANALYSIS OF THE INTESTINAL TRANSCRIPTOME OF MICE RESCUED FROM SEPSIS VIA A FECAL MICROBIOTA TRANSPLANT DEMONSTRATES A ROLE FOR IL-22Krezalek Monika, DeFazio Jennifer, Kim Sangman, Khodarev Nikolai, Zaborin Alexander, Christley Scott, Shakhsheer Baddr, Guyton Kristina, Jabri Bana, Zaborina Olga, Alverdy JohnThe University of ChicagoBackground: Post-surgical sepsis due to hospital acquired pathogens (PSS-HAP) is one of the most common causes of death in the surgical ICU. We recently demonstrated that PSS-HAP pathogenesis is driven by a critical loss of the intestinal “microbiome” leading to systemic immune dysregulation and mortality which can be reversed by a fecal microbiota transplant (FMT).Hypothesis: Here we hypothesize that the rescue effect of FMT is mediated in part by its ability to suppress IL-22.Methods: We modeled lethal gut-derived sepsis using mice subjected to a 30% hepatectomy followed by cecal inoculation with HAPs consisting of a multi-drug resistant human pathogen community isolated from the stool of a septic ICU patient. Mice showing signs of sepsis on POD1 were administered a fecal microbiota transplant (FMT) consisting of homogenized pooled mouse cecal contents versus control material consisting of autoclaved (AC) pooled cecal contents. Whole-genome transcriptional profiling was performed on cecal tissues using Illumina MouseRef-8 v2 arrays with functional analysis of differentially expressed genes using Ingenuity™ pathway analysis and DAVID software.Results: In the control AC group we noted systemic activation of pathways associated with adaptive and innate immunity, including TLR4/Myd88-dependent pro-inflammatory pathways. These pathways were significantly associated with over-expression of up-stream pro-inflammatory mediators: IL-1ß (13-fold), TNF-α (43-fold) and IL-17A (60-fold). We also noted increased expression of STAT3 (2.5-fold) and its downstream target genes (up to 140-fold). Treatment by FMT led to significant attenuation of these pathways on POD2 compared to AC. Given that STAT3 controls IL-22 expression and given the known relationship of IL-22 production to TLR4 signaling, we directly assayed IL-22 in these experiments via ELISA and qRT-PCR and observed that FMT suppresses IL-22 production compared to AC controls (2.5- and 8-fold reduction via ELISA and qRT-PCR respectively p<0.01). In order to determine the role of IL-22 in the FMT-mediated rescue effect, we treated septic mice with anti-IL22 antibody on POD1 and observed a significant reduction in mortality (AC=73%, anti-IL-22=40%, p<0.01), although FMT provided the lowest mortality (13%; p<0.001, n=15/group).Conclusions: Taken together, these studies suggest that FMT can rescue mice from severe post-surgical sepsis due to hospital-acquired pathogens via mechanisms involving, in part, IL-22 expression.O02. STATEWIDE EVALUATION OF INTRA-WOUND ANTIBIOTICS IN SPINE SURGERY PATIENTS: A REPORT FROM THE SCOAP-CERTAIN COLLABORATIVEPugel Anne, Khor Sara, Shonnard Neal, Oskouian RodJr., Sethi Rajiv, Cizik Amy, Lee Michael, Bederman Samuel, Dellinger E. Patchen, Flum DavidUniversity of WashingtonBackground: Surgical site infection (SSI) after spine surgery is classified as a never event but occurs up to 10% of the time, often with devastating consequences. Intra-wound antibiotics (IWA) have been proposed to reduce the incidence of spine SSI. Robust evidence to support IWA use is lacking.Hypothesis: We hypothesize that rates of SSI will differ between patients who did and did not receive IWA.Methods: We evaluated IWA use in a prospective cohort undergoing spine fusion surgery at 20 Washington State hospitals (July 2011-March 2014) participating in the Surgical Care and Outcomes Assessment Program Spine Program (Spine SCOAP). Patient, hospital, and operative covariates associated with SSI and IWA use during index hospitalizations were analyzed. Effects of IWA on SSI were examined using a random effects logistic model adjusting for patient and hospital characteristics. A propensity score-matching analysis was also performed independently to confirm our findings.Results: 9,646 cervical or lumbar fusions were completed during the study period (mean age 58 y, 90% white, 54% female). Nearly all (99%) received antibiotics on time, and 97% were normothermic in the recovery room. Overall, the infection rate was 1.1%. Those with SSI were more likely to be non-white (22% vs. 13%, p<0.01), older (64 vs. 58 years, p<0.01), to have diabetes mellitus (32% vs. 17%, p<0.01), and more frequently underwent lumbar versus cervical fusion (76% vs 52%, p<0.01). The unadjusted rate of SSI was 0.8% for those who received IWA and 1.5% for those who did not (OR: 0.56; p<0.01). The use of IWA varied widely across hospitals (10%-98.2%, p 20K or 0.05). More PP patients failed and required colectomy compared to LP (5/9 vs. 1/13, p=0.02). In-hospital mortality rates were 15% (2/13), 44% (4/9) and 41% (7/17) for the LP, PP, and direct colectomy groups, respectively (p=0.26). Of the 2 mortalities in the LP group, both had early deviations from protocol. One patient had active care withdrawn by family the day after LP was initiated, and died that day. The second patient started LP at a delayed stage, could not tolerate NJ irrigation on the first day of LP and thus, had immediate colectomy and died within 48 h. Mortality rates, excluding these 2 deaths, were significantly lower in the LP group (p=0.03).Conclusions: Colonic irrigation via NJ tube in the context of the LP appeared to be safe and effective in management of severe CDI. We found no significant differences in disease severity between groups. Per-protocol analysis shows mortality reduction with use of this approach. Intention-to-treat analysis shows that this approach does not lead to increased mortality.O05. HEPATOCYTES ARE A DOMINANT SOURCE OF HMGB1 IN THE INNATE IMMUNE RESPONSE DURING SEPSISDeng Meihong, Scott Melanie, Billiar TimothyUniversity of PittsburghBackground: High-mobility group protein B1 (HMGB1) is a nucleus-DNA binding protein, which is secreted into extracellular milieu as an inflammatory cytokine during seps
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