Abstract
BackgroundSecondary peritonitis is a common surgical emergence with deadly outcomes when not timely and promptly intervened. The emergence of Extended spectrum beta lactamase producing bacteria (ESBL) poses treatment challenge at Bugando Medical Centre (BMC); hence a need to evaluate the magnitude of ESBL so as to guide specific therapy.MethodsThis was a cross sectional study conducted at BMC from May 2014 to April 2015 involving patients with secondary peritonitis. A questionnaire was used to collect patients’ information. Peritoneal aspirate sample was collected intra-operatively and processed using standard operating procedures to identify bacteria species and their susceptibility profiles.ResultsThe study involved 97 patients with the median age (IQR) of 32 (21–47) years, males were 62 (63.9 %) and about 27 (27.8 %) patients had co-morbid illnesses. The prevalence of ESBL among patients with secondary peritonitis was 23.7 % (23/97). Of 53 gram negative Enterobacteriaceae isolated, 47.2 % (25/53) were ESBL producers, with predominance of Escherichia coli 7 (28.0 %) and Klebsiella spp 5 (20.0 %). The ESBL isolates exhibited more resistance rates to trimethoprim sulfamethoxazole and ciprofloxacin compared to non ESBL isolates 96.0 % versus 60.7 %, p value = 0.003 and 16.0 % versus 0.0 %, p value = 0.043 respectively). All isolates were sensitive to meropenem.ConclusionsThe prevalence of ESBL among patients with secondary peritonitis at BMC is high; with more resistance rates among ESBL compared to non ESBL isolates. There is a need for strengthen ESBL surveillance in this setting so as to guide specific therapy.
Highlights
Secondary peritonitis is a common surgical emergence with deadly outcomes when not timely and promptly intervened
The emergence of extended-spectrum beta lactamase (ESBL)-producing gram-negative infection in the past decade has made the management of gram-negative infections more difficult [7,8,9]; this in turn has necessitated a need to explore the magnitude of this problem across countries so as to confer specific therapy
Site and population This was a cross sectional hospital based study conducted from May 2014 to April 2015 at Bugando Medical Centre (BMC) in Mwanza region Tanzania involving 97 patients with secondary peritonitis admitted at BMC who consented to participate in the study
Summary
Secondary peritonitis is a common surgical emergence with deadly outcomes when not timely and promptly intervened. The emergence of Extended spectrum beta lactamase producing bacteria (ESBL) poses treatment challenge at Bugando Medical Centre (BMC); a need to evaluate the magnitude of ESBL so as to guide specific therapy. The emergence of extended-spectrum beta lactamase (ESBL)-producing gram-negative infection in the past decade has made the management of gram-negative infections more difficult [7,8,9]; this in turn has necessitated a need to explore the magnitude of this problem across countries so as to confer specific therapy. At Bugando Medical Centre (BMC), secondary peritonitis is the commonest indication for admission in the surgical wards; it is associated with significant workload, severe complications and deaths [6, 12, 13]. To ensure rational antimicrobial therapy to patients with secondary peritonitis, this study was conducted to determine the proportion of bacteriologically confirmed patients with secondary peritonitis due to ESBL and their drug susceptibility profiles
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