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Bacteria and septic complications in patients with perforated duodenal ulcers
Abstract:
To evaluate the clinical significance of bacterial contamination in perforated duodenal ulcers, we prospectively studied septic complications in 184 consecutive patients. All patients received parenteral antibiotics (over 90 percent preoperatively) for at least 7 days. Thirteen infections developed in eight patients (4.3 percent). Peritoneal cultures, performed in 143 unselected patients, were positive in 33.6 percent of cases. Bacterial growth occurred more often and in heavier amounts in patients who underwent exploration late (after 48 hours) and those who had gross peritoneal soilage. Candida and gram-negative organisms predominated, but there was no correlation with pathogens that produced abscesses or wound infections. Old age and late exploration significantly increased the risk of infection. Neither peritoneal soiling nor a positive culture was likely to be clinically important when explorations was performed within 2 days of perforation. We treated perforated ulcers as clean-contaminated cases, and recommend that three doses of prophylactic antibiotics be begun preoperatively in all patients.
Insights
Bacterial contamination in perforated duodenal ulcers rarely causes serious infection if treated promptly. Early surgical exploration within 48 hours minimizes risks associated with peritoneal soiling and positive cultures.
Area of Science:
- Gastroenterology
- Surgical Infections
- Microbiology
Background:
- Perforated duodenal ulcers can lead to serious septic complications.
- The role of bacterial contamination in these complications requires further clinical evaluation.
Purpose of the Study:
- To assess the clinical significance of bacterial contamination in perforated duodenal ulcers.
- To identify risk factors for septic complications in these patients.
Main Methods:
- Prospective study of 184 patients with perforated duodenal ulcers.
- Analysis of septic complications, peritoneal cultures, and patient factors (age, time to exploration, peritoneal soiling).
- All patients received parenteral antibiotics for at least 7 days.
Main Results:
- Septic complications occurred in 4.3% of patients.
- Peritoneal cultures were positive in 33.6% of cases.
- Late exploration (after 48 hours) and gross peritoneal soilage correlated with increased bacterial growth.
- Old age and late exploration were significant risk factors for infection.
- No correlation found between specific pathogens and abscess/wound infections.
Conclusions:
- Early surgical exploration (within 2 days) mitigates risks from contamination.
- Perforated duodenal ulcers should be treated as clean-contaminated cases.
- Recommend preoperative prophylactic antibiotics for all patients.