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

Abstract

Back ground: 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.

Key words: Aerobic, Bacteria, Secondary, Peritonitis. Antibiotic. Sensitivity, HIV negative, Bowel,
Perforation