Deolekar Samir, Patil Robin, Sawant Manasi, P Srinivasan
General Surgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND.
Urology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND.
Cureus. 2024 Jul 12;16(7):e64415. doi: 10.7759/cureus.64415. eCollection 2024 Jul.
Introduction One of the most frequent emergencies that a general surgeon deals with is perforation peritonitis. The anatomical site of the perforation, which in turn affects the source of infection, has a major impact on the mortality rate due to perforation peritonitis. Early and suitable antibiotic therapy can be started in the postoperative period with the aid of knowledge about the microbiological profile and sensitivity of peritoneal fluid culture with respect to the anatomical sites of perforation peritonitis. Methods A cross-sectional study was conducted from June 2021 to November 2021 where peritoneal fluid samples were collected intraoperatively from patients with perforation peritonitis. This was subjected to culture and sensitivity, and results were analyzed with respect to anatomical sites of perforation. Results Forty cases were investigated. The ileum (30%) was the most common site of perforation, followed by the stomach (22.5%), appendix (20%), duodenum (12.5%), caecum (5%), jejunum (5%), transverse colon (2.5%), and rectum (2.5%). () and spp. were the most frequently found organisms in all sites of perforation peritonitis. The most sensitive antibiotics covering all isolated organisms were amikacin and meropenem. Sensitivity to amikacin was found in 85.18% of cases of and 84.6% of cases of . Sensitivity to meropenem was found in 76.9% of cases of and 80% of cases of . Conclusion In patients with perforation peritonitis, the peritoneal fluid cultures did not reflect the major differential normal flora according to the region of the gastrointestinal tract. The most prevalent organism isolated among all the sites of perforation peritonitis was . Antimicrobial activity against organisms isolated from perforation peritonitis patients was significantly demonstrated by aminoglycosides, piperacillin and tazobactam, and meropenem and colistin, with considerable resistance to third-generation cephalosporins.
引言 普通外科医生最常处理的紧急情况之一是穿孔性腹膜炎。穿孔的解剖部位会影响感染源，进而对穿孔性腹膜炎的死亡率产生重大影响。借助关于穿孔性腹膜炎解剖部位的腹膜液培养的微生物学特征和敏感性的知识，可在术后开始早期且合适的抗生素治疗。
方法 于2021年6月至2021年11月进行了一项横断面研究，术中从穿孔性腹膜炎患者采集腹膜液样本。对其进行培养和敏感性分析，并根据穿孔的解剖部位分析结果。
结果 共调查了40例病例。回肠（30%）是最常见的穿孔部位，其次是胃（22.5%）、阑尾（20%）、十二指肠（12.5%）盲肠（5%）、空肠（5%）、横结肠（2.5%）和直肠（2.5%）。（）和 属是穿孔性腹膜炎所有部位最常发现的微生物。覆盖所有分离出的微生物的最敏感抗生素是阿米卡星和美罗培南。在 病例中，85.18%对阿米卡星敏感，在 病例中，84.6%对阿米卡星敏感。在 病例中，76.9%对美罗培南敏感，在 病例中，80%对美罗培南敏感。
结论 在穿孔性腹膜炎患者中，腹膜液培养未反映出根据胃肠道区域划分的主要正常菌群差异。在穿孔性腹膜炎所有部位分离出的最常见微生物是 。氨基糖苷类、哌拉西林和他唑巴坦、美罗培南和黏菌素对从穿孔性腹膜炎患者分离出的微生物具有显著抗菌活性，对第三代头孢菌素具有相当的耐药性。
