Program and AbstractsThirty-fourth Annual Meeting of the Surgical Infection SocietyBaltimore, MarylandMay 1–3, 2014
2014; Mary Ann Liebert, Inc.; Volume: 15; Issue: S1 Linguagem: Inglês
10.1089/sur.2014.9990.abstracts
ISSN1557-8674
Tópico(s)Innovations in Medical Education
ResumoSurgical InfectionsVol. 15, No. S1 AbstractsFree AccessProgram and AbstractsThirty-fourth Annual Meeting of the Surgical Infection SocietyBaltimore, MarylandMay 1–3, 2014Published Online:11 Apr 2014https://doi.org/10.1089/sur.2014.9990.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 sponsorship 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−. This includes 17 hours for the general scientific sessions and 4 hours for the post-graduate course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Disclosure InformationIn 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 ObjectivesThis activity is designed for physicians, research scientists, nurses, nurse practitioners, and pharmacists. Upon completion of this course, participants will be able to: • Summarize results on the latest research relevant to the diagnosis and treatment of surgical infections• Use antimicrobials for empiric treatment of VAP in trauma patients• Debate current controversies in the diagnosis and treatment of surgical infections• Use antimicrobials for a set course in the treatment of ventilator acquired pneumonia• Discuss recent developments in the study of infection in cellular and molecular mechanisms• Understand current treatment for secondary bacterial peritonitisProgramWednesday, April 30, 201419:00–21:30Presidential Dinner (By invitation) Thursday, May 1, 201407:00–07:30Executive Council Breakfast (By invitation)Sienna07:30–11:30Executive Council Meeting (By invitation)Sienna06:30–07:30BreakfastCobalt07:30–11:30Surgical Infection CourseBallroom Moderators: David Efron, MD and Stephanie Goldberg, MD BIOLOGY OF SEPSIS and PHARMACOLOGY 07:30–07:55Microbiology of surgical pathogensLena Napolitano07:55–08:20Biology and metabolism of sepsisTimothy Billiar08:20–08:45Organ physiology and multiple organ failure/dysfunctionJohn Marshall08:45–09:10Antimicrobials and antibiotic pharmacodynamicsPamela Lipsett09:10–09:20Q and A session 09:20–09:30Break RISK PREVENTION/PROPHYLAXIS 09:30–10:00Prevention of hospital-acquired infectionsE. Patchen Dellinger10:00–10:20Clostridium difficile InfectionsJohn Mazuski10:20–10:30Q and A session SPECIFIC INFECTIONS 10:30–10:55Necrotizing soft tissue infectionsBrian Harbrecht10:55–11:20Diagnosis and management of primary, secondary, and tertiary peritonitisMark Malangoni11:20–11:45High-risk patients: Who are they and how should they be managed?Soumitra Eachempati Q and A session 11:30–11:45Nominating Committee (By invitation)Sienna11:45–13:00LUNCHEON SYMPOSIUMCobalt (Industry sponsored, not part of scientific program) 13:00–16:45PLENARY SYMPOSIUMBallroom The Art and Science of Surgical Infections (Papers 1–10) Moderators: William Cheadle, MD and Nicholas Namias, MD O1. Replenishing the core gut microbiome via fecal microbiota transplant (FMT) can rescue mice from advanced-stage polymicrobial sepsis. Jennifer DeFazio (Resident), presenting. University of Chicago. Discussant: Greg Beilman, MDO2. The SIS study to optimize peritoneal infection therapy (STOP-IT) trial: Four days of antibiotics result in similar outcomes compared to duration. Robert Sawyer, presenting. University of Virginia. Discussant: Philip S. Barie, MD, MBAO3. Expression of MiR-21 is advantageous in the Immune Response to Peritonitis. Rebecca Barnett (Resident), presenting. University of Louisville. Discussant: Michael Morowitz, MDO4. A prospective randomized study to assess the optimal duration of antimicrobial prophylaxis in total gastrectomy. Ryoji Fukushima, presenting. Teikyo University School of Medicine. Discussant: J. Wesely Alexander, MDO5. Thrombin-processed Ecrg4 is chemotactic and recruits inflammatory monocytes to the injury site. Jisook Lee, presenting. University of California–San Diego. Discussant: Timothy Billiar, MDO6. Empiric azoles are not beneficial in surgical patients: A propensity-matched cohort study. Christopher Guidry (Resident), presenting. University of Virginia. Discussant: Pamela Lipsett, MD, MHEO7. TNF-Œ±, IL-6 and IL-8 cytokines in relation to TNF-Œ±-308 G/A polymorphism in postoperative sepsis. Kavita Baghel, presenting. King George's Medical University, India. Discussant: John Marshall, MDO8. Obstructive sleep apnea: A risk factor for surgical site infection after colectomy. Spyridon Fortis (Resident-New Member), presenting. University of Minnesota. Discussant: E. Patchen Dellinger, MDO9. Are functional single nucleotide polymorphisms of proinflammatory cytokines associated with the development of necrotizing enterocolitis or spontaneous perforation in premature infants? Ashanti Franklin (Resident), presenting. Children's National Medical Center. Discussant: Gary An, MDO10. Screening for ventilator-associated pneumonia in the surgical intensive care unit: Single-institution analysis of 1,013 bronchoalveolar lavages. Fredric D. Pieracci, presenting. Denver Health Medical Center/University of Colorado Health Sciences Center. Discussant: Lena Napolitano, MD16:45–17:30SIS Antibiotic Duration Study-Robert Sawyer, MDCobalt17:30–18:15Surgical InfectionsEditorial Reception (By Invitation)Azure18:15–19:00SIS Foundation Board Meeting(By Invitation)Cobalt19:00–20:30Welcome ReceptionPool DeckFriday, May 2, 201407:00–08:00BREAKFAST SYMPOSIUMCobalt (Industry-sponsored, not part of scientific program) 08:00–09:45PARALLEL SESSION IBallroom I Cellular and Molecular Mechanisms (Papers 11–15) O11. Cyclic adenosine monophosphate activation of protein kinase A may play a role in the pathogenesis of necrotizing enterocolitis. Catherine Hunter, presenting. Northwestern University. Discussant: Matthew Rosengart, MDO12. TNFR1 level in sepsis is dependent on MyD88-dependent upregulation of iNOS in hepatocytes. Meihong Deng (Resident/New Member), presenting. University of Pittsburgh. Discussant: Rachel Khadaroo, MDO13. Hepatic high motility group box-1 (HMGB1) levels are affected by invariant natural killer T-cells in polymicrobial sepsis. John Young (Resident), presenting. Brown University. Discussant: Ping Wang, PhDO14. Varying host response in different low-lethality models of murine abdominal sepsis. Lori Gentile (Resident), presenting. University of Florida. Discussant: Saman Arbabi, MDO15. Mitigation of splenocyte apoptosis by Th2-polarized invariant natural killer T-cells reduces disease severity in intra-abdominal sepsis. Ram Anantha (Resident), presenting. Schulich School of Medicine and Dentistry, Western University.08:00–09:45PARALLEL SESSION IIBallroom II Risk Factors and Surgical Infections (Papers 16–21) Moderators: E. Patchen Dellinger, MD and Heather Evans, MD Discussant: Daithi Heffernan, MDO16. Can nasal methicillin-resistant Staphylococcus aureus screening be used to avoid empiric vancomycin use in intra-abdominal infection? Puja Shah (Resident), presenting. University of Virginia. Discussant: Reza Askari, MDO17. A randomized, prospective study of surgical site infections following vascular reconstructive surgery: Untreated vs. silver-impregnated dressings. Amani Politano (Resident), presenting. University of Virginia. Discussant: Jill Cherry-Bukowiec, MDO18. Microbial analysis to predict anastomotic leak in humans. Preston Luong (New Member), presenting. University of Chicago. Discussant: Brian Zuckerbraun, MDO19. Vancomycin-associated nephrotoxicity: The obesity factor. Stephen Davies (Resident/New Member), presenting. University of Virginia. Discussant: Heather Evans, MDO20. Hypoalbuminemia in obese surgical patients is disproportionately associated with infectious complications. Zachary Dietch (Resident), presenting. University of Virginia. Discussant: Sheryl M. Sahr, MDO21. Complex pelvic surgery and additional organ resection independently increase the risk of wound infection after elective colorectal surgery: An ACS-NSQIP analysis. Mary Kwaan (New Member), presenting. University of Minnesota. Discussant: John M. Davis, MD09:45–10:00Break-Visit the Exhibits 10:00–11:00William A. Altemeier Memorial LectureBallroom “Warping disease space to improve recovery from infections” David S. Schneider, PhD and Associate Chair Associate Professor, Microbiology and Immunology Stanford University School of Medicine 11:00–12:00Surgical Infection Society Presidential AddressBallroom “The Wheel” Nicholas Namias, MD, MBA Professor and Chief, Division of Trauma and Acute Care Surgery Robert Zeppa Endowed Chair in Trauma Surgery Executive Vice Chairman, DeWitt Daughtry Family Department of Surgery University of Miami, Miller School of Medicine 12:00–13:15LUNCHEON SYMPOSIUMCobalt (Industry-sponsored;not part of scientific program) 13:30–15:15UPDATE SYMPOSIUM IBallroom GI Fistulae, Anastomotic Leak, and Other Abdominal Catastrophes Moderators: Tina Mele, MD and Samir S. Awad, MD Topic 1: Endoscopic Approaches to Source Control: Rajeev Attam, MD—University of MinnesotaTopic 2: Management of GI Fistulae, Soup to Nuts: David Efron, MD—The Johns Hopkins UniversityTopic 3: Microbial Pathogenesis of Anastomotic Leaks: John Alverdy, MD—University of ChicagoTopic 4: Closing the Infected Abdomen: If, When, How: Jose Diaz, MD—University of Maryland15:15–13:30Break-Visit the Exhibits 15:30–17:00PARALLEL SESSION IIIBallroom I Basic Mechanisms of Infection (Papers 22–27) Moderators: Timothy Billiar, MD and Daithi Heffernan, MD O22. Oncostatin M modulates immune cell recruitment and bacterial translocation in a murine model of sepsis. Pang Young (Resident), presenting. University of Alberta. Discussant: Tina Mele, MDO23. Association of inflammasomes and caspase-1 mediated cardiac dysfunction with sepsis. Deborah Carlson, presenting. University of Texas–Southwestern. Discussant: Brian Eliceiri, PhDO24. Invariant natural killer T-cells modulate the gamma-delta-lymphocyte response to polymicrobial sepsis. Whitney Young (Resident), presenting. Brown University. Discussant: Ping Wang, PhDO25. Glutamine improves innate immunity and the intestinal barrier function during parenteral nutrition. Rebecca Busch (Resident/New Member), presenting. University of Wisconsin–Madison. Discussant: Todd Costantini, MDO26. Mesenchymal stem cells reverse chronic stress induced bone marrow dysfunction following traumatic injury. Amy Gore (Resident), presenting. New Jersey Medical School-Rutgers. Discussant: William Cheadle, MDO27. Wound infection after attenuating a key inflammatory signaling pathway. Saman Arbabi, presenting. University of Washington. Discussant: Olga Zaborina, PhD15:30–17:00PARALLEL SESSION IVBallroom II Hospital Acquired and Skin/Soft Tissue Infections (Papers 28–33) Moderators: John Mazuski, MD, PhD and Addison May, MD O28. Reduction of infectious complications following trauma laparotomy through use of a perioperative antibiotic protocol. William Symons (New Member), presenting. Washington University. Discussant: Jeffrey Claridge, MDO29. Sustainability of a hospital-acquired pressure ulcer prevention bundle in surgical patients. Sylvia Martinez, presenting. Baylor College of Medicine. Discussant: Sandy Swoboda RN, MSNO30. Ventilator-associated events: Correlation with ventilator-associated pneumonia? Arek Wiktor (Resident/New Member), presenting. University of Michigan. Discussant: Fredric D. Pieracci, MD, MPHO31. Health-related quality of life among necrotizing soft tissue infection survivors and clinical predictors of poor outcome. Timo Hakkarainen (Resident), presenting. University of Washington. Discussant: Jeffrey G. Chipman, MDO32. A surgeon-directed peripherally inserted central catheter team utilizing a novel screening protocol to decrease infectious complications and associated cost. Vihas Patel (Resident), presenting. Brigham and Women's Hospital, Harvard University. Discussant: Laura Moore, MDO33. Predictors of mortality among intravenous drug users with staphylococcus aureus bacteremia. Ram Anantha (Resident), presenting. Schulich School of Medicine and Dentistry, Western University. Discussant: Colin Braithwaite, MD17:00–18:00Annual Business Meeting(Members only)Ballroom II18:00–19:00Committee Meetings (Attendance mandatory for committee members)CobaltSaturday, May 3, 201407:00–08:00Executive Council Meeting(By invitation)Sienna07:00–08:00BreakfastCobalt08:00–09:00UPDATE SYMPOSIUM II: PRO-CON DEBATESBallroom Moderators: Matthew R. Rosengart, MD The Double X Chromosome: Does Gender Really Matter in Human Disease? Speakers: PRO: Jason Sperry, MD, MPH—University of Pittsburgh CON: Addison May, MD—Vanderbilt University Is Zero Achievable in CLABSI, CAUTI, and VAP? Speakers: PRO: Madhuri Sopirala, MD-University of Cincinnati CON: Zero Dark Dirty!-Robert Sawyer, MD-University of Virginia 09:00–10:00UPDATE SYMPOSIUM IIIBallroom Advanced Platform Technologies: An Update Moderator: John Alverdy, MD Topic 1: A metagenomic approach to understand surgical infection-The role of next generation technology-Jack Gilbert, PhD-Argonne National LaboratoryTopic 2: Computational needs and approaches to manage metagenomic data-Scott Christley, PhD—University of ChicagoTopic 3: Statistical analysis of megadatasets-managing terabytes of data? Paul Bankey, MD, PhD—University of Rochester10:00–10:15FELLOWSHIP AWARD RECIPIENT PRESENTATIONSBallroom Moderators: Philip S. Barie, MD, MBA and Evan Nadler, MD SIS Foundation Resident Fellowship 2013 Kendall Sowards, MD SIS Foundation Junior Faculty Fellowship 2013 Jared Huston, MD 10:15–10:30Break–Visit the Exhibits 10:30–12:00PARALLEL SESSION V Proteins, Genes, and Pathogens (Papers 34–38)Ballroom I Moderators: John Marshall, MD and Rachel Khadaroo, MD, PhD O34. The enteric nervous system (ENS) neuropeptide, bombesin (BBS), maintains goblet cell function during parenteral nutrition (PN). Aaron Heneghan (New Member), presenting. University of Wisconsin–Madison. Discussant: Jared Huston, MDO35. Computational prediction of a novel transcriptional regulation for the PqsH encoding gene in Pseudomonas aeurginosa. Scott Christley, presenting. University of Chicago. Discussant: Kaysie Banton, MDO36. The genomic expression of aged murine hematopoietic stem cells after polytrauma indicates a failure to support development of innate immunity. Philip Efron, presenting. University of Florida. Discussant: Joseph Minei, MDO37. Ursodeoxycholic acid as a mediator of intestinal epithelial cell restitution. Stephanie Papillon (Resident), presenting. University of Southern California Children's Hospital Los Angeles. Discussant: Celeste Finnerty, PhDO38. NEC as an infectious disease: Identifying strains of opportunistic pathogens. Debi Thomas, presenting. University of Southern California Children's Hospital of Los Angeles. Discussant: Evan Nadler, MD10:30–12:00PARALLEL SESSION VI Clinical Issues in Surgical Infection (Papers 39–44)Ballroom II Moderators: Lillian Kao, MD and Jeffery Chipman, MD O39. A systematic approach to preventing sharps injuries in the operative care line at an urban tertiary care center. Sylvia Martinez, presenting. Baylor College of Medicine. Discussant: Peter A. Burke, MDO40. Acute kidney injury (AKI) causes persistent dysregulation of the leukocyte transcriptome. Benjamin Szpila (Resident), presenting. University of Florida. Discussant: David Efron, MDO41. External validation of the ventral hernia risk score for predicting surgical site infections. Mike Liang (New Member), presenting. University of Texas Health Sciences Center, Houston. Discussant: Donald Fry, MDO42. Use of computed tomography to diagnose aspiration in trauma patients. Vanessa Fawcett, presenting. University of Washington. Discussant: Patrick J. O'Neill, PhD, MDO43. Predictors of monomicrobial necrotizing fasciitis. Rhett Willis (Resident/New Member), presenting. University of Virginia. Discussant: Addison May, MDO44. Transforming growth factor beta induced epithelial-mesenchymal transition leads to persistent intestinal fistulae. Xiuwen Wu, presenting. Jinling Hospital, China. Discussant: Catherine Hunter, MD12:00–13:15LUNCHEON SYMPOSIUMCobalt (Industry-sponsored;not part of scientific program) 13:30–15:00PARALLEL SESSION VII Pathophysiologic Mechanisms of Infection (Papers 45–49)Ballroom I Moderators: Marc Jeschke, MD, PhD and Catherine Hunter, MD O45. Genomic and proteomic survival biomarker profiles in severely burned children. Celeste Finnerty, presenting. University of Texas Medical Branch, Galveston Shriners Hospitals for Children. Discussant: Marc Jeschke, MD, PhDO46. Intestinal bile acids differentially control intestinal cell proliferation. Avafia Dossa (Resident), presenting. University of Southern California, Children's Hospital Los Angeles. Discussant: Ziad Sifri, MDO47. The gut during prolonged critical illness harbors low membership pathogen communities that are less virulent as a group than individually. Olga Zaborina, presenting. University of Chicago. Discussant: Mary Kwaan, MDO48. Muscle injury and ischemia contribute to the pathogenesis of A. baumannii infection. Irma Fleming (Resident), presenting. University of Chicago. Discussant: Duane Hospenthal, MDO49. Differential immune and hormonal expression in cardiac versus hepatic blood after burn injury in rodents. Marc Jeschke (Resident), presenting. University of Toronto, Sunnybrook Health Sciences Centre. Discussant: Tina Palmieri, MD13:30–15:00PARALLEL SESSION VIII: The Surgical Infection Society Supreme Court (Papers 50–54)Ballroom II Moderators: Pamela Lipsett, MD, MHE, and Nicholas Namias, MD, MBA, John Alverdy, MD, Robert Sawyer, MD and E. Patchen Dellinger, MD O50. A Reappraisal of MRSA VAP in the surgical ICU: Not just a late infection any more. Jacquelyn Glenn, presenting. University of Colorado, Denver Health Medical Center.O51. Environmental contact versus patient contact in the ICU: What do we touch? Sandy Swoboda, presenting. Johns Hopkins University.O52. Early appropriate empiric antimicrobial prescribing in septic patients presenting to the emergency department does not lead to decreased mortality. James Gilmore (Resident), presenting. Brigham and Women's Hospital, Harvard University.O53. CAUTIs and CLABSIs: Do physicians REALLY know what they are? Therese Duane, presenting. Virginia Commonwealth University.O54. A comparison of ICU infections in a United States trauma center and a teaching hospital in Ho Chi Minh City, Vietnam. Andrew Stephens, presenting. Brown University.16:00–17:20POSTER SESSION (Posters 1–52)Ballroom Foyer Basic and Clinical Studies in Surgical Infection Moderators:Group A: (P1–P8) Olga Zaborina, PhD and Patrick J. O'Neill, PhD, MD Group B: (P9–P17) Brian Elicieri, PhD and Celeste Finnerty, PhD Group C: (P18–P27) Jeffery Tessier, MD and Therese Duane, MD Group D: (P28–P33) Kaysie Banton, MD and David Blake, MD Group E: (P34–P43) Reza Askari, MD and Howard Belzberg, MD Group F: (P44–P52) Christine S. Cocanour, MD and Samir Awad, MD 19:00–20:00New Member ReceptionBallroom Foyer20:00–22:00Awards BanquetBallroom22:00ADJOURNMENT Oral Presentation AbstractsO-01. REPLENISHING THE CORE GUT MICROBIOME VIA FECAL MICROBIOTA TRANSPLANT (FMT) CAN RESCUE MICE FROM ADVANCED-STAGE POLYMICROBIAL SEPSISDeFazio JenniferKim SangmanChristley ScottFleming IrmaShakhsheer BaddrJabri BanaZaborina OlgaAlverdy JohnUniversity of ChicagoBackground: During critical illness, the normal gut microbiota are replaced by virulent and multi-drug resistant (MDR) healthcare acquired pathogens (HAPs).Hypothesis: The aim of this study was to test the hypothesis that replenishing the microbiota with a fecal microbiota transplant (FMT) could rescue mice with advanced stage polymicrobial sepsis due to HAPs.Methods: We developed a novel model of lethal polymicrobial gut-derived sepsis due to MDR-HAPs in mice. Mice underwent a 30% hepatectomy with intestinal inoculation of a well characterized MDR human pathogen community (HPC) from the stool of a patient dying of sepsis. 100% of mice developed clinically apparent severe sepsis at 24 hours confirmed by positive cultures of the HPC in the lung, liver, spleen and blood (n=24) with only 30% surviving to day 7. In reiterative experiments, when mice appeared frankly septic at 24 hours, they were assigned to receive either a fecal microbiota transplant (FMT- cecal contents of normal, healthy mice in H20) or an autoclaved (AC) FMT via enema. When moribund, mice were sacrificed and underwent 16S rRNA analysis of the gut microbiota on cecal contents and tissues. Filtered cecal lysates were inoculated onto bone marrow-derived dendritic cells (BMDCs) to assess the direct effect of the microbiota on immune function.Results: FMT resulted in an 87% survival rate as compared to AC which resulted in only 17% survival (n=15/group, p<0.001). FMT mice appeared completely healthy on POD 7. 16S rRNA showed a shift of the microbiota at the initiation of sepsis and in all groups through POD 7 (p<0.05). There was also a significant decrease in Enterobacteriaceae and Enterococcus in FMT vs. AC (p<0.05). The presence of Coprobacteriaceae was associated with survival during FMT treatment (p<0.05). BMDC assays demonstrated differentially expressed cytokines between groups; IL-6 and IL-10 were increased in the FMT mice compared to AC mice (P<0.05). Finally, the BMDC assays performed on healthy appearing surviving mice on POD7 from both groups demonstrated that FMT microbiota induced cytokines at a low baseline level compared to AC microbiota which remained proinflammatory as judged by IL-6, 10, 12, RANTES, and TNF (P<0.01).Conclusions: Fecal microbiota transplant rescued mice from advanced stage polymicrobial sepsis due to MDR- HAPs possibly owing to its effect on both local and systemic immune function.O-02. THESIS STUDY TO OPTIMIZE PERITONEAL INFECTION THERAPY (STOP-IT) TRIAL: FOUR DAYS OF ANTIBIOTICS RESULT IN SIMILAR OUTCOMES COMPARED TO DURATION BASED ON RESOLUTION OF PHYSIOLOGICAL RESPONSESawyer RobertClaridge JeffreyNathens AveryDuane ThereseEvans HeatherCook CharlesO'Neill PatrickMazuski JohnAskari RezaWilson MarkNapolitano LenaNamias NicholasMiller PrestonDellinger E. PatchenWatson ChristopherCoimbra RaulDent DanielLowry StephenMoncure MichaelCocanour ChristineWest MichaelBanton KaysieFlynn WilliamLipsett PamelaPopovsky KimberleyUniversity of VirginiaBackground: After source control, antibiotics are required to clear pathogens from the peritoneum. The most effective duration of antimicrobial therapy in this setting is unclear.Hypothesis: The administration of four days of antibiotics after source control leads to outcomes equivalent to a strategy where antibiotics are administered for two days beyond resolution of physiologic abnormalities.Methods: The trial was a 23-center, randomized, controlled study of four days of antibiotics after source control (4 day) versus antibiotics given for two days beyond resolution of fever (T≥38), leukocytosis (WBC≥11), and ileus, with a maximum of 10 days (clinical response-CR). Antibiotic regimens adhered to SIS guidelines. The primary outcome was a composite of surgical site infection, recurrent intra-abdominal infection, and death within 30 days per group allocation (intent-to-treat). Secondary outcomes included rates of extra-abdominal infection and subsequent infections with resistant pathogens, including C. difficile.Results: 521 patients were enrolled: 263 in the CR group and 258 in the 4 day group. Colon/rectum was the most common source (159), followed by appendix (70), and small bowel (69). APACHE II was similar between groups: CR=9.8±0.4 (SEM), 4 day=10.1±0.4. Median duration of antibiotics with interquartile range (IQR) was 8 (5–10) days in the CR group and 4 (4–5) days in the 4 day group (p<0.01 by Mann-Whitney U test). There was no difference in the composite or component endpoints. No difference was found in rates of subsequent infection with resistant pathogens or C. difficile. There were fewer patients with extra-abdominal infections (principally urinary tract infections) in the CR day group than the 4 day group (17/263=6.5% versus 31/258=12%, p=0.028 by Pearson χ2 test).Conclusions: Four days of antibiotics to treat intra-abdominal infections after source control yields outcomes similar to a longer course based on resolution of physiologic abnormalities and is associated with significantly fewer days of antibiotic exposure. We recommend this approach as standard of care.O-03. EXPRESSION OF MIR-21 IS ADVANTAGEOUS IN THE IMMUNE RESPONSE TO PERITONITISBarnett RebeccaSepulveda ErnestoCheadle WilliamUniversity of LouisvilleBackground: Peritonitis may trigger sepsis and organ failure, with most mortality due to the latter. Innate immune modulation allows a directed response to pathogens and minimal collateral organ injury. MicroRNA-21 (miR-21) is a short non-coding RNA with targets in the toll-like receptor (TLR) signaling pathway, and may facilitate the switch from pro- to anti-inflammatory phases of the innate response to peritonitis.Hypothesis: Macrophage miR-21 modulates the innate immune response, resulting in a reduction of pro-inflammatory cytokines.Methods: 8–12 week WT and miR-21−/− C57BL/6 mice were given peritonitis by intra-peritoneal injection of lipopolysaccharide (LPS). Temperature, daily weight and survival were recorded. Bone marrow-derived macrophages from WT and miR-21−/− mice were plated and stimulated with LPS. MiR-21 and cytokine levels were measured at 0, 3, 6, 12, 24 and 48 hours. Peritoneal macrophages were transfected with miR-21 mimics and antagomirs for 24 hours, and stimulated with LPS. Cytokines were measured in the supernatant after 6 hours.Results: Knockouts did not express miR-21. Although WT mice began to die earlier, more miR-21−/− mice died overall (p=0.002). MiR-21−/− macrophages produced significantly less IL-10 at 3, 6 and 12 hours after stimulation (p<0.05). IL-6/TNF-α was significantly higher at 12 and 48 hours (p<0.05) in the miR-21−/− cultures. The increase in TNF-α/IL-6 were also seen after transfection with miR-21 antagomir and subsequent LPS stimulation (p=0.02 and 0.1 respectively). An increase in IL-10 was seen after transfection of miR-21 mimic and LPS stimulation (p=0.02).Conclusions: Expression of miR-21 conferred a survival benefit from LPS peritonitis, related to targets in the TLR pathway and ultimately cytokine production of the innate response. Identification of patients with overwhelming pro-inflammatory response could allow treatment to reduce the increased inflammatory load and improve organ damage and outcomes.Survival from peritonitis in WT and miR-21−/− miceO-04. A PROSPECTIVE RANDOMIZED STUDY TO ASSESS THE OPTIMAL DURATION OF ANTIMICROBIAL PROPHYLAXIS IN TOTAL GASTRECTOMYFukushima RyojiKonishi ToshiroMohri YasuhikoNoie TamakiOno SatoshiOmura KenjiSueyoshi SusumuTakagane AkinoriKusunoki MasatoShibata TaroMochizuki HidetakaSumiyama YoshinobuTeikyo University School of MedicineBackground: Western guidelines state that the duration of antimicrobial prophylaxis (AMP) should be less than 24 hours postoperatively for most surgical procedures. However, some patients after gastrectomy especially in Japan still receive further extended AMP until 3–4 postoperative days. In contrast to Western countries, extended D2 lymphadenectomy has been a standard surgical treatment for gastric cancer in Japan (and in Eastern Asia) and high prevalence of drain use may be a potential risk for surgical site infections (SSI). There is not much information regarding the optimal duration of AMP in total gastrectomy with D2 lymphadenectomy.Hypothesis: A muti-center prospective, open-label, randomized controlled trial to assess the optimal duration of AMP in total gastrectomy was conducted.Methods: Patients with gastric cancer who underwent total gastrectomy (R0 resections) were randomly assigned (1:1) to group A: 24-hour AMP (ampicillin/sulbactam 1.5 g before the surgical incision and every 3 hour during surgery, 6 hours after wound closure and once on the next day) or group B: 72-hour AMP (ampicillin/sulbactam 1.5 g twice daily extended until postoperative day 3). The primary endpoint was the incidence of SSI and the secondary endpoint was the incidence of remote infections. We assessed non-inferiority of 24-hour prophylaxis with a margin of 9%. This study was registered in UMIN-CTR, UMIN000001062.Results: Between February 28, 2008, and March 31, 2012, 476 patients from 67 hospitals were included and 462 patients were analyzed (group A: n=227, group B: n=235). The two groups did not differ significantly in relation to age, sex, body mass index, cancer stages and operative procedures. Incidences of infections are presented in the table. The results showed statistically significant non-inferiority (p<0.0001) of group A over group B in terms of the incidence rate of SSI.Conclusions: Antimicrobial prophylaxis should be limited to 24 hours postoperatively in total gastrectomy.O-05. THROMBIN-PROCESSED Ecrg4 IS CHEMOTACTIC AND RE
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