Abstract
Introduction: Peritonitis is an inflammation of the serosal membrane that borders the abdominal cavity and its organs. Peritonitis is most commonly caused by an infection entering the ordinarily sterile peritoneal environment through intestinal perforation, such as a ruptured appendix or colonic diverticulum. Complicated intra-abdominal infections are life-threatening illnesses that require immediate source control and antibiotic therapy. Knowing the microbial dispersion by anatomical site of perforation is critical, because knowing the geographical distribution and features of bacteria will allow for the best empirical antibiotic choice. It can be produced via culturing of intraoperatively acquired peritoneal fluid. The purpose of this study is too evaluated of the perforation peritonitis microbiological profile with respect to the anatomical site of perforation.
Material and method: Patients suspected of having perforation peritonitis received imaging with X-ray abdomen supine and chest posteroanterior erect film with both domes of diaphragm to confirm the diagnosis after a complete history and physical examination. The CT abdomen was performed based on the case's merits. As per the patients requirement routine laboratory investigations were done including random blood sugar, renal function tests, hemogram, arterial blood gas analysis etc. Patients were taken up for emergency exploratory laparotomy through a vertical midline incision after receiving broad spectrum antibiotic therapy. In respect to the site of perforation, intraoperative results were noted. The collected specimen was used for direct gram staining and inoculated on blood agar and MacConkey agar. The inoculated plates were incubated overnight at 350C. After the incubation the bacterial identification was done by conventional biochemical tests.
Result: 60 patients were studied. The mean age of the patients in this study was 33.76±14.7 years.(Table 1). The male:female ratio was 6.14:1. The most common site of perforation was stomach (n=26) (43.33%) followed by Appendix (n=14) (23.33%) and least was Ileum (n=9) (15%). Among 60 cases of perforation peritonitis. Out of culture positives, E. coli was isolated in maximum cases, Acinetobacter spp. was least.
Conclusion: In the peritoneal fluid culture of patients with perforation peritonitis and E. coli was the most common organism isolated in all sites of perforation peritonitis. The antibiotic sensitivity profile showed the increasing resistance against third generation cephalosporins, which have been commonly in use empirically. However Aminoglycosides still have a significant sensitivity profile. Piperacillin and tazobactum, meropenem and colistin also showed a significant antimicrobial activity against organisms isolated from cases of perforation peritonitis.
Keyword: Peritonitis, E. coli, antibiotic sensitivity.