CLINICOPATHOLOGICAL AND MICROBIOLOGICAL PROFILE OF PERFORATION PERITONITIS AND ITS ASSOCIATION WITH POSTOPERATIVE OUTCOMES
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Keywords
Perforation peritonitis, gastrointestinal perforation, microbiological profile, antimicrobial resistance, postoperative complications, Escherichia coli, Klebsiella pneumoniae, mortality
Abstract
Background: Perforation peritonitis is a major surgical emergency associated with substantial morbidity and mortality. Its outcome is influenced by the anatomical and pathological characteristics of perforation, extent of contamination, microbiological profile, antimicrobial resistance, and timing of surgical intervention. The present study evaluated the clinicopathological and microbiological profile of perforation peritonitis and their association with postoperative outcomes.
Materials and Methods: A prospective observational study was conducted among 90 patients with perforation peritonitis undergoing surgical management. Demographic, clinical, laboratory, radiological, operative, pathological, and microbiological characteristics were recorded. Peritoneal fluid or pus obtained intraoperatively was subjected to culture and antimicrobial susceptibility testing. Patients were followed during hospitalization for postoperative complications, intensive care requirement, duration of hospital stay, and mortality.
Results: The mean age of patients was 48.7 ± 16.2 years, with male predominance (70.0%). Duodenal perforation was the commonest anatomical site (32.2%), while perforated peptic ulcer disease was the predominant etiology (42.2%). Generalized peritonitis was present in 67.8% of patients. Peritoneal cultures were positive in 80.0%, with Escherichia coli (38.9%) and Klebsiella pneumoniae (25.0%) being the predominant isolates. Polymicrobial infection occurred in 33.3% of culture-positive cases, while multidrug-resistant organisms were identified in 34.7%. Postoperative complications occurred in 43.3% of patients, with surgical-site infection being the commonest (21.1%). ICU admission was required in 15.6%, and in-hospital mortality was 10.0%. Complications were more frequent with generalized peritonitis, feculent contamination, bowel necrosis, polymicrobial infection, and MDR organisms.
Conclusion: Clinicopathological and microbiological characteristics were important determinants of postoperative outcomes in perforation peritonitis. Early surgical source control, microbiological evaluation, appropriate antimicrobial therapy, and close postoperative monitoring may improve outcomes.
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