[Bacteriological studies of peritonitis].

Bacterial infections of the peritoneum may be primary (pneumococcal peritonitis of childhood). These are rare, as are Streptococcal and Staphylococcal peritonitis in the neonate, following umbilical or tegumental infections. The great majority of cases of peritonitis are secondary to an adjacent inflammation, a perforation of the gastro-intestinal tract, or trauma, which may be surgical in origin. The microbial flora involved is generally mixed, with a high proportion of anaerobic organisms, reflecting the composition of the intestinal flora, and in particular, that of the colon. Infections due to a single organisms are less common, and are seen principally in superinfected ascites, high perforations, or following preoperative antibiotic therapy. The treatment of peritonitis is thus dependent upon the microbial flora present. In mixed infections, broad spectrum antibiotic therapy (amino-glycosides + beta lactamines) is necessary, combined with a b-nitro-ionidazole derivative in view of the frequent presence of Bacteroides fragilis. When the infection is due to one or a limited number of organisms, only the antibiotic sensitivy will provide useful indications. The dangers of preoperative "sterilization", which leads only to the selection of multiresistant strains, is emphasized. Such sterilization is thus to be proscribed in the prevention of peritonitis. Antibiotic cover, on the other hand, is still indicated.