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Bacterial and Antibiotic Sensitivity Pattern in Secondary Peritonitis
Adedoyin Babatunde Ojo1, David Omoareghan Irabor2
1Department of Surgery, University College Hospital, Ibadan, Nigeria.
Background:
Peritonitis is inflammation of the peritoneum usually as a result of a localized or generalized infection. Secondary peritonitis which is the most common type follows an infective process in a visceral organ. The role of peritoneal cultures and use of antibiotics effective against culture results remain controversial.
Objectives:
This study was conducted to determine the bacterial and antibiotic sensitivity pattern in patients with secondary peritonitis. It also compared the use of empirical antibiotics and culture-sensitive antibiotics with outcomes of patients with secondary peritonitis.
Materials And Methods:
A prospective randomized clinical study was conducted. Five millilitres of peritoneal fluid was sampled intra-operatively, and microscopy, culture, and sensitivity testing was performed in patients with secondary peritonitis. The patients, randomized into two groups, had antibiotics administered for 7 days. The first group had empirical antibiotics throughout (Ceftriaxone + Metronidazole), whereas the second group had empirical antibiotics (Ceftriaxone + Metronidazole) for the first 2 days and antibiotics according to the sensitivity report for the remaining 5 days. The post-hoc analysis was also done on a third group, who, even though were randomized to either groups, had no growth on culture of peritoneal fluid.
Results:
The commonest pathogens identified from the peritoneal culture of the participants were Escherichia coli, Klebsiella pneumonia, Anaerococcus group, and Bacteroides fragilis. Complications including mortality were significantly higher in those who received empirical antibiotics than those who received culture-sensitive antibiotics.
Conclusion:
The outcome of antibiotics administration in patients with secondary peritonitis with a positive culture was better in those who received culture-sensitive antibiotics than those who received empirical antibiotics.
Insights
Culture-guided antibiotics significantly improved outcomes for secondary peritonitis patients compared to empirical treatments. This study highlights the benefit of tailoring antibiotic therapy based on peritoneal culture results to reduce complications and mortality in secondary peritonitis.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Microbiology
Background:
- Peritonitis, particularly secondary peritonitis, arises from visceral organ infections.
- The optimal use of peritoneal cultures and targeted antibiotic therapy remains debated.
- Secondary peritonitis is the most common form, often stemming from localized or generalized infections.
Purpose of the Study:
- To identify common bacterial pathogens and their antibiotic sensitivity patterns in secondary peritonitis.
- To compare patient outcomes between empirical and culture-sensitive antibiotic administration.
- To evaluate the efficacy of tailored antibiotic regimens in secondary peritonitis.
Main Methods:
- A prospective randomized clinical study involving peritoneal fluid sampling and analysis.
- Patients received 7-day antibiotic courses, with one group on empirical therapy and another on initial empirical followed by culture-sensitive therapy.
- Post-hoc analysis included patients with negative peritoneal cultures.
Main Results:
- Common pathogens included Escherichia coli, Klebsiella pneumonia, Anaerococcus group, and Bacteroides fragilis.
- Significantly higher complication and mortality rates were observed in the empirical antibiotic group.
- Culture-sensitive antibiotic therapy led to better outcomes in patients with positive peritoneal cultures.
Conclusions:
- Culture-sensitive antibiotic administration is superior to empirical therapy for secondary peritonitis with positive cultures.
- Tailoring antibiotic treatment based on sensitivity testing improves patient outcomes.
- This approach reduces complications and mortality in secondary peritonitis.
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