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Bacteriology of Secondary Peritonitis and Relationship to Surgical Site Infection in a Tertiary Health Establishment in Southern Nigeria

Introduction

Bacteriology of secondary peritonitis and relationship to surgical site infection in a tertiary health establishment in southern nigeria. Examines bacteriology of secondary peritonitis from GI perforation and its link to surgical site infection in Southern Nigeria. E. coli & Klebsiella are key pathogens, revealing high SSI rates.

Abstract

Background: Peritonitis secondary to gastrointestinal perforation is associated with high morbidity and mortality rates. The outcome is dependent on multiple factors, but significantly on early diagnosis and prompt intervention. The principles of management are based on fluid resuscitation, initiation of appropriate antibiotic therapy, surgical intervention, and management of associated co-morbid conditions. Aim and Objectives: To determine the bacterial flora of the peritoneal fluid culture in secondary peritonitis resulting from gastrointestinal perforation and relate the findings to the bacterial flora of surgical site infections/morbidity in patients presenting to Irrua Specialist Teaching Hospital. Study Design: This is a prospective study of 64 consecutive patients with secondary peritonitis due to gastrointestinal perforation. Methodology: All patients who were laparotomised for secondary peritonitis had their intraperitoneal fluid sent for microscopy, aerobic culture, and sensitivity. Intravenous ceftriaxone and metronidazole were administered to all the patients pre-operatively. Postoperatively, the wounds were assessed on days 3, 5, 7, 14, and 30 for surgical site infection (SSI). The concordance rate of the microorganism-isolated from peritoneal and wound culture was calculated using the formula: Concordance Rate = Number of Concordant Pairs Number of Concordant Pairs+Number of Discordant Pairs X 100 Results: Sixty-four patients who met the inclusion criteria were selected for the study. The mean age was 43.9 ± 16.3 years (range: 18-74 years). There were 43 (67.2%) males and 21 (32.8%) females, with a male to female ratio of 2:1. The mean duration of hospitalization was 12.4 days (range: 6-30 days) with predominant site of perforation being gastroduodenal (n=27, i.e., 42.2%), followed by ruptured appendicitis (n=24, i.e., 37.5%). Of the 64 peritoneal fluid specimens sent for microscopy, culture, and antibiotic sensitivity, 55 (85.9%) yielded bacterial growth. The bacteria most frequently isolated from peritoneal fluid were Escherichia coli (20; 31.3%) and Klebsiella (14; 21.9%). There was no growth in 9 (14.1%). Escherichia coli was sensitive to ceftriaxone in 70.3%, piperacillin-tazobactam in 74.0%, and meropenem in 95.4% of cases. Klebsiella pneumoniae was sensitive to ciprofloxacin in 70.0%, ceftriaxone in 70.2%, piperacillin-tazobactam in 67.0%, and meropenem in 79.1% of cases. The overall surgical site infection (SSI) rate was 16 in 64 patients (25.0%), with 14 cases (21.9%) being superficial SSIs and 1 case (1.6%) each of deep SSI and organ space infection. Conclusion: Escherichia coli was the most commonly isolated microorganism in cases of peritonitis secondary to gastrointestinal perforation and the subsequent SSI, followed by Klebsiella, Staphylococcus aureus, mixed growth of Staphylococcus aureus and Escherichia coli, Pseudomonas aeruginosa, and Candida.

Review

This prospective study investigates the bacterial flora of secondary peritonitis due to gastrointestinal perforation and its relationship to surgical site infections (SSI) in a tertiary health establishment in Southern Nigeria. Addressing a condition associated with high morbidity and mortality, the authors conducted a focused analysis of peritoneal fluid cultures from 64 patients, alongside postoperative wound assessments. A key strength lies in its regional focus, providing valuable, context-specific epidemiological data on the predominant microorganisms, notably *Escherichia coli* and *Klebsiella*, and their antibiotic susceptibility patterns. The detailed reporting of sensitivities to commonly used antibiotics, such as ceftriaxone, piperacillin-tazobactam, and meropenem, offers practical guidance for local empirical antibiotic selection, which is critical in resource-limited settings. The study also usefully reports the overall SSI rate and classifies the types of SSI observed. While providing important insights, the abstract reveals several areas where the study's impact could be enhanced through more comprehensive reporting. Crucially, the abstract states an objective to "relate the findings to the bacterial flora of surgical site infections," and the methodology describes calculating a "concordance rate," yet the results section *fails to present the actual microbial isolates from the SSIs* or the calculated concordance rate between peritoneal and wound cultures. This omission significantly weakens the stated aim of linking these two critical aspects. Furthermore, the abstract notes the high morbidity and mortality associated with peritonitis in the background, but the study does not report on these important clinical outcomes, limiting its assessment of overall patient prognosis. While pre-operative antibiotics are mentioned, the specifics of post-operative antibiotic management and how it was tailored based on culture results are not detailed, which is a vital component of peritonitis care. Despite these limitations, this study represents a commendable effort to characterize the bacteriology of secondary peritonitis and SSI in a specific Nigerian context. The identification of *Escherichia coli* as the most prevalent pathogen, followed by *Klebsiella*, aligns broadly with global literature but provides essential local validation for empirical treatment protocols. To maximize the utility and scientific rigor of this work, future iterations or the full paper should explicitly present the SSI culture results and the calculated concordance rates to substantiate the proposed link between peritoneal and wound pathogens. Incorporating patient outcome data (e.g., mortality, length of hospital stay post-SSI) and discussing the implications of observed antibiotic resistance patterns more deeply would also significantly enrich the findings. Overall, this research provides a foundational understanding but would benefit from a more exhaustive presentation of its data and a broader assessment of clinical impact.

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