Background:
Intra-abdominal infections are commonly encountered in surgical practice and
represent a major cause of morbidity and mortality. The most common aetiology is contamination
of the peritoneal space by endogenous micro-flora among patients with gastro intestinal
perforations. Inappropriate antibiotic therapy of secondary peritonitis may result in poor patient
outcomes. The selection of an appropriate empirical antibiotic agent can be challenging amidst
limited laboratory infrastructure and the emerging resistance to commonly prescribed antibiotics.
This study was aimed at determining the aerobic bacterial causes of secondary peritonitis and their
antibiotic sensitivity patterns among HIV negative patients with non-traumatic small bowel
perforations in Mbarara Regional Referral Hospital so as to guide initial empirical treatment.
Methods:
This was a cross-sectional study in which 87 consenting patients with non-traumatic
small bowel perforation confirmed at laparotomy, on the emergency ward of Mbarara Regional
Referral Hospital were enrolled consecutively from September 2011 to May 2012. HIV testing and
peritoneal fluid analysis was done for all patients enrolled into the study.
Results:
Majority of patients had either
Klebsiella
spp (37.9%) or
Escherichia coli
(26.4%) on
peritoneal fluid culture, while 12 (13.8%) had no growth at all. Four patients (4.6%) had more than
one organism cultured. Most of the organisms were susceptible to Ceftriaxone followed by
Ciprofloxacin and Gentamycin. Peritoneal fluid gram stain showed gram negative bacilli in 79.3%
of the cases while peritoneal fluid ZN stain did not demonstrate any AAFBs. All patients tested HIV
negative.
Conclusions:
The results indicated that secondary peritonitis among HIV negative patients with
non-traumatic small bowel perforation at MRRH was mainly due to
Klebsiella spp and
E. coli
which were mainly sensitive to cephalosporins, quinolones and aminoglycosides.
