A study on peritoneal fluid culture and its antibiotic sensitivity in perforative peritonitis patients in CMCH

BACKGROUND: Peritonitis remains one of the most common problems faced by a General surgeon. Only in recent decades there has been significant improvement in treatment of peritonitis both by use of antibiotic and surgery. The surgeons treating it know the dreadful and fatal complication, the problems can be minor wound infection to dangerous septic shock or SIRS (systemic inflammatory response syndrome). The treatment can be done easily by starting a certain line of antibiotic therapy these usually include a broad spectrum antibiotic that covers gram positive, gram negative and anaerobes. However the problem now is the development of resistance to these antibiotics and results in high failure rates in the treatment. AIMS AND OBJECTIVES: 1. To study bacteriological pattern in peritoneal fluid by culture. 2. To determine antibiotic sensitivity and resistance pattern for commonly used antibiotics to the organisms grown in culture. MATERIALS DESIGN OF STUDY: Cross sectional study. PLACE OF STUDY: Coimbatore Medical College and Hospital. STUDY PERIOD: AUGUST 2014-JULY 2015. STUDY POPULATION: Patients presenting to Coimbatore medical college hospital with perforation peritonitis. SAMPLE SIZE: 50. INCLUSION CRITERIA: 1. Patient presenting with features of perforation peritonitis and confirmed by x ray 2. Age more than 18 yrs EXCLUSION CRITERIA: 1. Patient presenting with primary peritonitis 2. Peritonitis due to trauma METHODOLOGY: PRE OPERATIVE EVALUATION - Patients with features of perforation peritonitis presenting to casualty to Coimbatore medical college were admitted. Following which detailed history were taken and complete physical examination were done and diagnosis is confirmed using chest and abdomen X ray erect which shows air under diaphragm. Following which routine investigations like CBC, Blood urea and sugar and serum creatinine and electrolytes and ECG were done. PREOPERATIVE PREPARATION - Patient confirmed with diagnosis of perforation peritonitis were resuscitated with intravenous fluid and stabilising the patient vitals were planned for emergency laparotomy and taken up for surgery after getting consent from the patient and his/ her attenders. INTRAOPERATIVE PROCEDURE - Emergency laparotomy done using midline incision and peritoneal fluid was obtained from confirmed non traumatic cases and sent for aerobic microbiological culture. Following which perforation closure is done using vicryl with live omental patch and abdomen is closed after keeping abdominal drains. POST OPERATIVE CARE - Following surgery patient were given routine postoperative care with intravenous fluids and antibiotics. Peritoneal fluid culture reports were followed up and the isolated organisms were tested for antimicrobial sensitivity by Kirby-Bauer disc diffusion method using ampicillin, amikacin, ciprofloxacin, ceftriaxone and cotrimoxazole and the culture reports were obtained. Antibiotics were changed according to the sensitivity pattern of organism grown in the culture. LIMITATION OF THE STUDY: 1. Study population is small, 2. Shorter duration of study. OBSERVATION AND RESULTS: AGE DISTRIBUTION - Age Number: 20 to 30 yrs 13, 31 to 40 yrs 18, 41 to 50 yrs 10, >50 yrs 9. This study shows that the most common age group of presentation is about 31 to 40 yrs (36%) followed by 20 to 30 yrs (26%). The mean age of presentation is being 35.26 yrs. SEX DISTRIBUTION: - Sex Number - Male 44, Female 6. The sex distribution in this study shows perforation being more common in male (88%) than female (12%). This finding is comparable to most of the related studies. DISCUSSION: Secondary peritonitis caused by hollow viscus perforation is common. It has high mortality rate due to late presentation of patient to hospital. In our study most of the cases of perforation were seen in the age group of 31-40yrs followed by 20 – 30 yrs. The mean age of presentation is 35.26 yrs of age. From our study, it has been noticed that the most common site of perforation is in 2nd part of duodenum 52% followed by gastric in 42% of cases. The most common organism grown were Klebsiella 46% followed by E coli in 34% of cases only 2% showed mixed growth of both E coli and Klebsiella. In our study, the sensitivity patterns of cultured organisms were analysed. It showed that organisms were sensitive in most cases to ceftriaxone followed by ciprofloxacin and amikacin. CONCLUSION: In this study, it is concluded that perforation most commonly seen in duodenum followed by stomach. Most of the cases were due to peptic ulcer disease. Secondary peritonitis caused in these cases was most commonly due to Klebsiella followed by Escherichia coli and rarely by mixed, proteus and pseudomonas. Both Klebsiella and Escherichia coli were sensitive to cephalosporin group of drugs followed by quinolones and then macrolide antibiotics