Publication:

Peritoneal fluid culture and its antibiotic sensitivity in perforative peritonitis patients – a prospective observational study from Southern India

Background Multiple microorganisms, including anaerobic bacteria, gram positive and gram-negative bacteria, enter the peritoneal cavity during peritonitis. We studied the microbiological pattern in peritoneal fluid cultures and t the organisms' antibiotic susceptibility and resistance pattern in perforative peritonitis.

Methods This study was a cross-sectional study conducted for 12 months with 50 patients. The patients presenting with features of perforation peritonitis aged above 18 years were included in the study. Emergency laparotomy done using midline incision and peritoneal fluid was obtained from confirmed the non-traumatic cases and sent for aerobic microbiological culture. Peritoneal fluid culture reports were followed up and the antibiotics were changed according to the sensitivity pattern of organism.

Results Mean age of the study participants was 42.6±15.1 years. Study participants were predominantly male 36 (72%). Nine (58%) does not have any comorbidities. All patients presented with 50 (100%) abdominal pain followed by predominant symptom was vomiting 44 (88%), nausea 29 (58%), oliguria 7 (14%) and anorexia 3 (6%). Among patients without comorbidities, E. coli was the pre-dominant organism isolated 16 (55.2%) followed by Klebsiella 9 (31%), Proteus 3 (10.3%) and Pseudomonas 1 (3.4%). Maximum number of patients were sensitive to ceftriaxone 47 (94%) followed by ciprofloxacin 41 (82%). Maximum number of patients were resistant to higher end antibiotic like ampicillin 46 (92%) followed by co-trimoxazole 45 (90%).

Conclusions Perforation most commonly seen in antral followed by duodenum. Common etiology found out was peptic ulcer disease. In this study, all organisms showed maximum sensitivity to ceftriaxone followed by ciprofloxacin and amikacin. Hence its recommended to administer empirical therapy with combination of cephalosporins/ fluroquinolones/ aminoglycosides and metronidazole.