Microbiological analysis of peritoneal fluid samples from patients with perforated peptic ulcer - retrospective observational study
Abstract
Introduction: Peritonitis due to perforated peptic ulcer (PPU) is a surgical emergency associated with high mortality. Preoperative management includes immediate initiation of broad-spectrum antimicrobial therapy.
The objective of this study was to assess the spectrum of microbial pathogens in peritoneal fluid. Methods: Retrospective observational study of patients who underwent surgery for PPU at the 1st Department of Surgery - Thoracic, Abdominal and Injury Surgery, General University Hospital in the period 2015-2020.
Analysis of the microbiological analytical results of peritoneal fluid. Results: The microbiological profile of PPU-associated peritonitis is somewhat different from microbial pathogens involved in secondary peritonitis due to bowel perforation.
A high rate of negative culture findings, high incidence of Candida spp. and low incidence of anaerobic bacteria are characteristic for PPU-associated peritonitis. Negative culture from the peritoneal fluid collected during surgery was identified in 42% of the patients.
A total of 66 isolates of microbial pathogens were identified, including Candida spp. (42.5%), aerobic gram-positive bacteria (30.3%), aerobic gram-negative bacteria (22.7%) and anaerobic bacteria (4.5%). Candida albicans and Candida glabrata represented the most common species.
Decreased susceptibility to fluconazole and resistance to itraconazole was associated with all Candida glabrata isolates. Conclusion: Although PPU-associated peritonitis is mostly of community origin, we confirmed a significant incidence of Candida spp. with decreased azole susceptibility.
The choice of antifungal therapy should always be based on local epidemiology.