Ramakrishnaiah Vishnu Prasad Nelamangala, Chandrakasan Chandramaliteswaran, Dharanipragadha Kadambari, Sistla Sujatha, Krishnamachari Srinivasan
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Trop Gastroenterol. 2012 Oct-Dec;33(4):275-81. doi: 10.7869/tg.2012.70.
This study was conducted to elucidate the spectrum of community acquired acute bacterial peritonitis, the role of microbiological culture in its management and other factors affecting its outcome.
This was a prospective study wherein we examined cases of secondary bacterial peritonitis admitted and operated at our institution from January 2005 to May 2006. The peritoneal fluid was sent for bacterial culture and sensitivity testing. Patients were followed up with relevant progress details till discharge or death.
We enrolled 352 patients. The mean age of the study population was 42.4 years with a male:female ratio of 7:1. Gastroduodenal perforations formed the major site of perforation (51%), followed by small bowel (29%) and appendicular perforations (17%). Culture positivity rate was 64%. Escherichia coli and Klebsiella species were the predominant isolates from peritoneal fluid. These main isolates were predominantly sensitive to ceftazidime, amikacin and chloramphenicol. Ampicillin with gentamicin and metronidazole was the first line of treatment used preoperatively in 67% of the patients, given its low cost and easier availability. The overall morbidity and mortality rates were 52% and 16.5% respectively. 78% of patients received inadequate antibiotics preoperatively. Only 26% had appropriate change of antibiotics postoperatively.
There was no significant benefit of postoperative change of antibiotics based on culture results. Analysis of factors influencing mortality shows dominance of host related factors over the type and source of infection with high risk population identified by age > 60 years, delayed presentations > 3 days and APACHE II score > 15.
本研究旨在阐明社区获得性急性细菌性腹膜炎的范围、微生物培养在其治疗中的作用以及影响其预后的其他因素。
这是一项前瞻性研究，我们检查了2005年1月至2006年5月在我院收治并接受手术的继发性细菌性腹膜炎病例。将腹腔液送去进行细菌培养和药敏试验。对患者进行随访，记录相关进展细节直至出院或死亡。
我们纳入了352例患者。研究人群的平均年龄为42.4岁，男女比例为7:1。胃十二指肠穿孔是穿孔的主要部位（51%），其次是小肠（29%）和阑尾穿孔（17%）。培养阳性率为64%。大肠杆菌和克雷伯菌属是腹腔液中的主要分离菌株。这些主要分离菌株对头孢他啶、阿米卡星和氯霉素大多敏感。鉴于氨苄西林联合庆大霉素和甲硝唑成本低且易于获得，67%的患者术前将其作为一线治疗药物。总体发病率和死亡率分别为52%和16.5%。78%的患者术前抗生素使用不足。术后仅有26%的患者适当更换了抗生素。
根据培养结果术后更换抗生素并无显著益处。对影响死亡率的因素分析表明，宿主相关因素比感染类型和来源更具主导性，年龄>60岁、就诊延迟>3天和急性生理与慢性健康状况评分系统II（APACHE II）评分>15被确定为高危人群。
