A 60-Year-Old Man Undergoes a Laparotomy for Intestinal Obstruction Secondary

A 60-year-old man undergoes a laparotomy for intestinal obstruction secondary to postoperative adhesions from a cholecystectomy 2 years ago.  His other medical problems include type 2 diabetes mellitus, hypothyroidism, and hypertension.  On postoperative day 3, he complains of intense pain around his laparotomy wound.  His temperature is 38.3 C (101 F) , blood pressure is 121/76 mm Hg, pulse is 100/min, and respirations are 16/min.  Examination of the wound shows abundant cloudy-gray discharge and dusky, friable subcutaneous tissue.  Sensation is decreased at the wound edges.  His serum glucose level is 312 mg/dL.  Which of the following is the most appropriate next step in management of this patient?

A) Daily dressing changes and tight glucose control
B) Parenteral antibiotics and negative-pressure wound therapy
C) Parenteral antibiotics and observation
D) Parenteral antibiotics and urgent surgical debridement
E) Topical antibiotics and observation

Correct Answer:

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