A prospective evaluation of prevalence of microbial flora and significance of intraoperative Peritoneal culture of fungus in perforation Peritonitis

Abstract

Objective: To study the prevalence of intraabdominal flora and significance of intraoperative peritoneal fluid culture of fungus in patients with perforation peritonitis. Study design: Prospective study. Methods: In this study, we analyzed 91 patients of gastrointestinal perforation admitted during the period from January 2011 to July 2012 in Department of Surgery. Any patient undergoing exploratory laparotomy for gastrointestinal perforation above 5 years was included. Intraoperative abdominal fluid samples were collected and cultured. Results: Ninety one patients of gastrointestinal perforation were studied. The mean presenting age was 35.21+ 12.87 years. Gastro duodenal perforation was the commonest (48.35%), 34.07% were having ileal perforation, 6.59% were having appendicular perforation , 5.49% were having jejunal and 5.49% had large bowel perforation. Out of 91 patients, 79 (86.8%) patients showed growth of either bacteria or fungus and in 12 (13.2%) patient’s culture was sterile. Gram positive cocci was found in 46.1%, E.Coli in 40.65%, Klebsiella in 14.28%, Enterobacter in 1.098% and Pseudomonas in 1.089% of patients. Fungal growth was seen in 48.3% of patients. Patients with fungal positive culture had superficial surgical site infection in 77.27%, deep surgical site infection 59.09% and residual abscesses formation in 27.27% of cases. Patient with no growth of fungus have superficial site infection in 40%, deep surgical site infection in 25.71% and residual abscess formation in 5.71%. Conclusion: Positive peritoneal fungal co-infection is a bad prognostic factor and a significant risk factor for adverse outcome in perforation peritonitis.