Role of Peritoneal Fluid Culture and Sensitivity for appropriate Antibiotic Therapy in Perforative Peritonitis

Abstract

Background: Perforative peritonitis is a severe, life-threatening condition resulting from gastrointestinal perforations, leading to bacterial contamination of the peritoneal cavity. Early and targeted antibiotic therapy, guided by knowledge of local bacterial profiles and resistance patterns, is essential for improving clinical outcomes in affected patients. Objectives: To determine the bacterial pattern of peritoneal fluid based on culture; and to ascertain the antibacterial susceptibility of the isolated organisms. Methods: This was a hospital based analytical cross-sectional study conducted in the Department of Emergency Medicine and inpatient wards of the Government Thiruvarur Medical College and Hospital, Thiruvarur, Tamil Nadu, India between May 2021 and May 2022. Results: The study analysed 60 patients with a mean age of 49.4 years, predominantly male (90%). The duration of symptoms varied, with 18.3% presenting with symptoms lasting ≤1 day, 70% for 2-3 days, and 11.7% for over 4 days. Notably, 70% had no comorbidities. The most common site of perforation was the duodenum (50%), followed by the gastric region (40%). Surgical interventions included omental patch closure (83.3%), with a 95% survival rate; 80.7% of survivors recovered within 10 days. Peritoneal fluid cultures revealed 6.7% with no bacterial growth. Klebsiella was the most common organism isolated (40%), followed by E. coli (33.3%). Mixed cultures were found in 11.7%, with Proteus and Pseudomonas isolated less frequently. Organism distribution varied by perforation site; for instance, in gastric perforations, Klebsiella was found in 41.7% of cases, while E. coli and Klebsiella each accounted for 40.7% in duodenal perforations. Antibiotic sensitivity testing showed that 96.7% of isolates were susceptible to ciprofloxacin, with 78.3% sensitivity to ceftriaxone and amikacin. Sensitivity to ampicillin and cotrimoxazole was lower at 48.3%. Conclusion: This study highlights critical demographic, clinical, and microbiological aspects of patients with gastrointestinal perforations.