An observational study on peritoneal fluid bacteriology in cases of gastrointestinal perforations, antibiotic management and outcome in tertiary care center

Abstract

Background: Perforative peritonitis is one of the most common surgical emergencies in India. Perforation of the intestines results in the potential for bacterial contamination resulting in peritonitis.Methods: A total of 65 patients (January 2018 to Dec 2018) who presented with features of perforative peritonitis admitted to various surgical units of PES institute of medical sciences, Kuppam were included in this study. The following study was conducted to analyze bacteriology of peritoneal fluid, to assess antibiotic sensitivity pattern, to assess its impact on morbidity, mortality pattern in these cases.Results: Males outnumbered females with a ratio of 4.9:1. The most common site of perforation was pre-pyloric part of stomach (35.3%), followed by an appendix (33.8%). Peritoneal fluid was negative for culture (21.5%) in the majority of cases. Culture was positive for E. coli in 27.6% of cases and Klebsiella in 18.4% of cases, respectively. Majority of the isolated strains were sensitive to cephalosporins, quinolones, aminoglycosides. Most common postoperative complications were wound infection, respiratory complications, death.Conclusions: Studies have shown that delay in management and treatment will affect the prognosis. Empiric antimicrobial therapy is initiated and changed accordingly with peritoneal fluid culture sensitivity reports. This may reduce the incidence of postoperative complications, morbidity, and mortality.