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Microbiological analysis of peritoneal fluid samples from patients with perforated peptic ulcer - retrospective
Introduction:
Peritonitis due to perforated peptic ulcer (PPU) is a surgical emergency associated with high mortality. Preoperative management includes immediate initiation of broad-spectrum antimicrobial therapy. The objective of this study was to assess the spectrum of microbial pathogens in peritoneal fluid.
Methods:
Retrospective observational study of patients who underwent surgery for PPU at the 1st Department of Surgery - Thoracic, Abdominal and Injury Surgery, General University Hospital in the period 2015-2020. Analysis of the microbiological analytical results of peritoneal fluid.
Results:
The microbiological profile of PPU-associated peritonitis is somewhat different from microbial pathogens involved in secondary peritonitis due to bowel perforation. A high rate of negative culture findings, high incidence of Candida spp. and low incidence of anaerobic bacteria are characteristic for PPU-associated peritonitis. Negative culture from the peritoneal fluid collected during surgery was identified in 42% of the patients. A total of 66 isolates of microbial pathogens were identified, including Candida spp. (42.5%), aerobic gram-positive bacteria (30.3%), aerobic gram-negative bacteria (22.7%) and anaerobic bacteria (4.5%). Candida albicans and Candida glabrata represented the most common species. Decreased susceptibility to fluconazole and resistance to itraconazole was associated with all Candida glabrata isolates.
Conclusion:
Although PPU-associated peritonitis is mostly of community origin, we confirmed a significant incidence of Candida spp. with decreased azole susceptibility. The choice of antifungal therapy should always be based on local epidemiology.
Insights
Peritonitis from perforated peptic ulcers often shows Candida species, with some resistant to azoles. Local epidemiology should guide antifungal treatment choices for this surgical emergency.
Area of Science:
- Microbiology
- Surgical Infections
- Clinical Medicine
Background:
- Perforated peptic ulcer (PPU) peritonitis is a critical surgical emergency with high mortality rates.
- Prompt broad-spectrum antimicrobial therapy is crucial in preoperative management.
- Understanding the microbial landscape of peritoneal fluid is essential for effective treatment.
Purpose of the Study:
- To investigate the spectrum of microbial pathogens present in peritoneal fluid of patients with PPU peritonitis.
- To characterize the microbiological profile and compare it with secondary peritonitis from bowel perforation.
Main Methods:
- Retrospective observational study conducted from 2015-2020.
- Analysis of microbiological results from peritoneal fluid samples of patients undergoing surgery for PPU.
- Identification and characterization of isolated microbial pathogens.
Main Results:
- A significant proportion (42%) of peritoneal fluid cultures were negative.
- Candida species (42.5%) were the most prevalent pathogens, followed by aerobic gram-positive (30.3%) and gram-negative bacteria (22.7%).
- Anaerobic bacteria were infrequently identified (4.5%). Candida albicans and Candida glabrata were the most common Candida species, with C. glabrata showing decreased susceptibility to fluconazole and resistance to itraconazole.
Conclusions:
- PPU-associated peritonitis exhibits a distinct microbiological profile, notably with a high incidence of Candida species.
- Reduced susceptibility to azole antifungals, particularly in Candida glabrata, necessitates careful consideration.
- Antifungal treatment strategies should be informed by local epidemiological data and resistance patterns.
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