Implications of Bacteriological Study in Perforated Peptic Ulcer Peritonitis

Background: In the setting of perforated pepticulcer (PPU) peritonitis, empiric antimicrobial therapy is initiated perioperatively and adapted according to the culture sensitivity. This attitude may reduce the incidence of postoperative complications. The aim of the study is to describe the microbiota found in the peritonitis due to a PPU, and to evaluate the predictors for bacterial or fungal infection. Material and methods We performed a single-centre, retrospective observational study of all consecutive patients who presented with PPU peritonitis and underwent emergent surgery in Saint Pierre University Hospital, Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance and postoperative outcomes were analysed. Results A total of 43 patients were included in the study. The microbiological culture rate was positive in 31% (13/43) patients, with presence of bacteria in 20.9% (9/43) and fungal infection in 16.7% (7/43) patients. The bacterial culture revealed that the most frequently isolated bacteria were Klebsiella spp . and Enterobacter in 7% (3/43) of the patients, while the most prevalent fungus isolation was Candida spp. in 16.7% (7/43) patients. There was as overall resistant rate of 17.5%. The most prevalent resistances were against ampicillin (17.1% [7/43]), and amoxicillin/clavulanic acid (9.5% [4/43]). The Charlson Comorbidity Index was an independent predictor for bacterial infection. No factors could be identified as predictors of fungal infection. Conclusion Candida spp. , Klebsiella spp . and Enterobacter were the most common organisms isolated in the setting of PPU peritonitis.