Epidemiology and Microbiology of Secondary Peritonitis Caused by Viscus Perforation: A Single-Center Retrospective Study

Abstract

BACKGROUND: Complicated intra-abdominal infections are serious conditions that require urgent source control and antibiotic treatment. The purpose of this study was to evaluate the epidemiology and bacterial causation of such infections using blood and peritoneal cultures of Korean patients with peritonitis originating from viscus perforation.

METHODS: The medical records of 419 consecutive patients who underwent emergency surgery because of bowel perforation from January 2007 to December 2011 were analyzed. Clinical characteristics, peri-operative conditions, perforation sites, and mortality data were obtained. Bacterial distributions and antibiotic resistance were evaluated using blood and peritoneal culture reports.

RESULTS: The most common perforation site was the colon (165; 39.4%), and the overall mortality rate was 11.2%. Blood cultures were performed in 182 patients, and 20 patients (11.0%) had a positive culture. Blood culture positivity was significantly higher for colon perforations (17.7%) than perforations elsewhere (p=0.039). A peritoneal culture was performed for each of 210 patients (50.1%), and 145 of those patients (69.0%) had a positive culture. Enterococcus faecium (35.2%) was the most common gram-positive bacterium, and Escherichia coli was the most common gram-negative organism. There were 276 community-acquired infections (CAI) (65.9%) and 143 hospital-acquired infections (HAI) (34.1%). Escherichia coli producing extended-spectrum β-lactamases were more common in the HAI than in the CAI group (p=0.016).

CONCLUSIONS: The compositions and antibiotic resistances of micro-organisms found in this study are similar to those reported previously. A multicenter prospective study is needed of this disease state in South Korea.