Community acquired secondary bacterial peritonitis in a tertiary hospital of South India: an audit with special reference to peritoneal fluid culture.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.