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Value of cultures of tissue samples taken at operation for lower intestinal perforation
1Department of Surgery, University of Alberta, Edmonton.
Abstract:
Tissue cultures from perforations of the lower intestinal tract commonly yield both aerobes (coliform organisms) and anaerobes (Bacteroides sp. and Clostridium sp.). To determine the consistency of this pattern and the value of intraoperative cultures, the authors reviewed the hospital records of 115 patients with perforation of the appendix (100 patients) or colon (15 patients), treated between 1987 and 1990, in whom organisms were cultured from tissue samples taken intraoperatively. Attention was paid to the organisms cultured, their distribution and antibiotic sensitivity in initial samples and in subsequent samples obtained when there were septic complications. On average, 4.7 bacterial isolates per patient were obtained. The common organisms were as expected: Bacteroides fragilis, Escherichia coli and Clostridium sp. Although the culture results did not affect the management of these patients, the sensitivity of Bacteroides fragilis to cefoxitin was found to be lower than expected, indicating a shift in sensitivity.
Insights
Intraoperative cultures from intestinal perforations consistently identify aerobes and anaerobes. Notably, a decreased sensitivity of Bacteroides fragilis to cefoxitin was observed, suggesting evolving antibiotic resistance patterns.
Area of Science:
- Microbiology
- Surgical Infectious Diseases
Background:
- Intestinal perforations frequently involve polymicrobial infections with both aerobic and anaerobic bacteria.
- Intraoperative cultures are often obtained to guide treatment, but their consistency and impact require evaluation.
Purpose of the Study:
- To assess the consistency of microbial patterns in tissue cultures from lower intestinal perforations.
- To evaluate the clinical utility of intraoperative cultures in managing appendiceal and colon perforations.
- To monitor the antibiotic sensitivity of common pathogens, particularly Bacteroides fragilis.
Main Methods:
- Retrospective review of 115 patients with appendiceal or colon perforation treated between 1987 and 1990.
- Analysis of intraoperative tissue cultures, including organism identification, distribution, and antibiotic sensitivity.
- Comparison of initial cultures with samples from subsequent septic complications.
Main Results:
- An average of 4.7 bacterial isolates per patient were identified.
- Common organisms included Bacteroides fragilis, Escherichia coli, and Clostridium species, consistent with expectations.
- A lower-than-expected sensitivity of Bacteroides fragilis to cefoxitin was detected, indicating a potential shift in resistance.
Conclusions:
- Intraoperative cultures from intestinal perforations reliably detect expected aerobic and anaerobic organisms.
- While culture results did not alter patient management in this cohort, the observed decrease in Bacteroides fragilis sensitivity to cefoxitin warrants attention.
- Ongoing surveillance of antibiotic resistance patterns is crucial for effective treatment of intra-abdominal infections.