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Outcome of intra-operative Purulent Peritoneal Fluid Aspirate Culture Results during Appendicectomy in Patients'
Ukoha Agwu Kalu1,2, Josephine Walshaw2, Vyjayanthi Ravi2
1Department of General Surgery, William Harvey Hospital, Ashford, Kent, United Kingdom.
Background:
Intra-operative purulent peritoneal fluid aspirate for microscopy, culture, and sensitivity during appendicectomy is practiced by some surgeons to help in the post-operative management of patients if the patients get unwell, requiring a change of the prescribed pre-operative antibiotics. This study aimed to evaluate if there are benefits from purulent peritoneal fluid aspirate culture results during appendicectomy.
Methodology:
This was a retrospective review of medical records and operation notes of all the patients who had an appendicectomy with purulent peritoneal fluid that was aspirated for microscopy culture and sensitivity in the last 3 years (May 2019 to April 2022).
Results:
A total of 73 patients had purulent peritoneal fluid culture results and received perioperative intravenous antibiotics. There were 52 (71%) bacteriological positive culture results from the purulent peritoneal fluid aspirates and 21 (29%) negative peritoneal pus culture results. The most common antibiotics administered were a combination of co-amoxiclav and metronidazole 45 (61.6%). One-quarter of the preoperative antibiotics were changed due to the positive microbiology culture results from the peritoneal pus aspirates. The main reasons for the change in antibiotics were intra-abdominal collections and wound infection in 21 (28.8%) of the patients, and Streptoccocus anginosus was the most common organism isolated. A re-operation and/or ultrasound-guided drainage of intra-abdominal collections were avoided in 13 out of 17 patients due to the change of the pre-operative antibiotics following the results from the purulent peritoneal fluid.
Conclusion:
The intra-operative purulent peritoneal fluid culture results during appendicectomy contributed positively towards the post-operative management of patients.
Insights
Intra-operative peritoneal fluid cultures during appendicectomy guide antibiotic changes, improving patient outcomes. This approach helped avoid re-operations and drainage in many cases.
Area of Science:
- Surgical Infectious Diseases
- Microbiology
- Clinical Management
Background:
- Appendicectomy is a common surgical procedure.
- Intra-operative peritoneal fluid aspiration for culture is sometimes used to guide post-operative antibiotic management.
- The clinical utility of this practice requires further evaluation.
Purpose of the Study:
- To evaluate the benefits of intra-operative purulent peritoneal fluid aspirate culture results during appendicectomy.
- To determine if culture results positively impact post-operative management and patient outcomes.
Main Methods:
- Retrospective review of medical records and operation notes.
- Inclusion criteria: patients undergoing appendicectomy with purulent peritoneal fluid aspiration for microscopy, culture, and sensitivity (May 2019 - April 2022).
- Analysis of culture results, antibiotic administration, and clinical outcomes.
Main Results:
- 73 patients had purulent peritoneal fluid cultures; 52 (71%) were positive.
- Antibiotic regimens were changed in one-quarter of patients based on culture results.
- Changes in antibiotics, guided by cultures, helped avoid re-operation or drainage in 13 of 17 patients, particularly for intra-abdominal collections and wound infections.
- Streptococcus anginosus was the most common organism isolated.
Conclusions:
- Intra-operative purulent peritoneal fluid culture results during appendicectomy offer positive contributions to post-operative patient management.
- Tailoring antibiotic therapy based on intra-operative findings can lead to improved clinical outcomes and potentially reduce the need for further interventions.
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