Microbiological profile and antimicrobial susceptibility of perforation peritonitis in a tertiary care Hospital
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Abstract
Background: Perforation peritonitis is a life-threatening surgical emergency with reported mortality ranging from 17% to 63%. Empirical antibiotic selection remains challenging due to regional variation in microbial flora and emerging antimicrobial resistance. Institution-specific bacteriological data are essential for guiding rational therapy.
Objectives: To study the bacteriological profile and antibiotic sensitivity patterns of peritoneal fluid in patients with perforation peritonitis and to assess whether the anatomical site of perforation influences the bacterial spectrum.
Methods: An observational, cross-sectional, hospital-based study was conducted at RDGMC & CRGH, Ujjain, from 2024 to 2025. Ninety-six patients undergoing emergency laparotomy for perforation peritonitis were enrolled. Intraoperative peritoneal fluid was subjected to Gram stain, aerobic culture, and antibiotic susceptibility testing by the Kirby–Bauer disc diffusion method (CLSI guidelines).
Results: Male predominance was noted (80.2%). Mean age was 47.46 ± 15.16 years. Gastric (43.8%) and ileal (39.6%) perforations were most common. Culture positivity was 70.8%; Escherichia coli was the predominant isolate (34.4%), followed by Klebsiella pneumoniae (12.5%) and Enterococcus spp. (8.3%). Aminoglycosides (gentamicin 38.5%, tobramycin 35.4%, amikacin 32.3%) and carbapenems (meropenem 29.2%) showed the highest sensitivity. Resistance to third-generation cephalosporins and fluoroquinolones was high. Ileal perforations were significantly associated with bacterial growth and mortality (p = 0.001). Overall mortality was 15.6%.
Conclusion: E. coli remains the dominant organism in peritoneal infections. High resistance to conventional antibiotics necessitates empirical regimens incorporating aminoglycosides or carbapenems, guided by local antibiogram data. Ileal perforations carry the highest septic burden and mortality risk, warranting aggressive early intervention.
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