A clinico-microbiological profile in patients with perforated peptic ulcer with special reference to anaerobic organisms: a descriptive study
DOI:
https://doi.org/10.18203/2349-2902.isj20164301Keywords:
Anaerobic infection, Morbidity, Mortality, Perforated peptic ulcerAbstract
Background:Gastrointestinal (GI) perforations have been surgical problems since time immemorial. Perforated peptic ulcer (PPU) is associated with aerobes, anaerobes and fungal infection. There is paucity of data regarding anaerobic isolates in perforated peptic ulcer. The purpose of the present study was to determine the clinico-microbiological profile of perforated peptic ulcer with special reference to anaerobes and to assess the impact of anaerobes on morbidity and mortality due to perforated peptic ulcer.
Methods: The present study included consecutive patients admitted and operated for PPU from September 2010 to June 2012. Pre-operative ultrasound guided peritoneal fluid aspirate was analysed for aerobic and anaerobic bacteria. Patients were followed until their discharge from the hospital or death. Correlation between clinical profile and anaerobic infection and morbidity and mortality associated with anaerobic infection were assessed.
Results:The study included 275 consecutive patients with PPU diagnosed intra-operatively. Anaerobic organisms were identified in 9.45% patients. Age > 50 years, lag period ≥ 48 hours, peritoneal contamination, length of hospital stay, presence of co-morbidities, shock at presentation, need for ventilator assistance, need for inotropes, chest infection, wound infection, intra-abdominal abscess, wound dehiscence and septicemia were found to be significantly associated with anaerobic infection (p <0.05). Lag period >24 hours (p = 0.018) and chest infection (p = 0.038) were independent risk factors for mortality.
Conclusions:Anaerobic infection in peritoneal fluid was associated with an increase in morbidity but without a significant increase in mortality.
References
Gupta SK, Gupta R, Singh G, Gupta S. Perforation peritonitis: a two year experience. J Med Education Res. 2010:12(3);141-4.
Pai D, Sharma A, Kanungo R, Jagdish S, Gupta A. Role of abdominal drains in perforated duodenal ulcer patients: a prospective controlled study. Anz J Surg. 1999;69:210-3.
Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg. 2009;33(8):1600-4.
Behrman SW. Management of complicated peptic ulcer disease. Arch Surg. 2005;140:201-8.
Post PN, Kuipers EJ, Meijer GA. Declining incidence of peptic ulcer but not of its complications: a nation-wide study in The Netherlands. Aliment Pharmacol Ther. 2011;23:1587-93.
Shinagawa N, Muramoto M, Sakurai S, Fukui T, Hori K, Taniguchi M. A bacteriological study of perforated duodenal ulcers. Jpn J Surg. 1991;21:1-7.
Fong IW. Septic complications of perforated peptic ulcer. Can J Surg. 1983;26:370-2.
Chandramaliteeswaran C, Srinivasan K, Kadambari D. An audit of secondary bacterial peritonitis with special reference to peritoneal fluid culture. Pondicherry university (Unpublished data). 2014.
Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231:153-8.
Gupta S, Kaushik R, Sharma R, Ashok Attri .The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15.
Taleb AK, Razzaq RA, Kathiri ZO. Management of perforated peptic ulcer in patients at a teaching hospital. Saudi Med J. 2008;29:245-50.
Pramod J, Srinivasan K. Detection of candida in intra operative peritoneal specimen in perforation peritonitis and its significance on the outcome of the patient. 2012.
Taha AS, Angerson WJ, Prasad R, Mccloskey C, Gilmour D, Morran CG. Clinical trial: the incidence and early mortality after peptic ulcer perforation, and the use of low-dose aspirin and nonsteroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2008;28:878-85.
Boey J, Lee NW, Koo J, Lam PH, Wong J, Ong GB. Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial. Ann Surg. 1982;196:338-44.
Berne TV, Donovan AJ. Non operative treatment of perforated duodenal ulcer. Arch Surg. 1982;124:830-2.
Blomgren LG. Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg. 1997;21:412-4.
Griffin GE, Organ CH. The natural history of the perforated duodenal ulcer treated by suture plication. Ann Surg. 1976;183:382-5.
Jordan GL, Debakey ME, Duncan JM. Surgical management of perforated peptic ulcer. Ann Surg. 1974;179:628-33.
Yıldırım M, Engin O, Ilhan E, Coskun. Risk factors and mannheim peritonitis index for the prediction of morbidity and mortality in patients with peptic ulcer perforation. Ulus Cerrahi Derg. 2015; 31(1): 20-5.
Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer. 2012;12:26-35.
Sharma SS, Mamtani MR, Sharma MS, Kulkarni H. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer. BMC Surg. 2006;6:8.
Barut I, Tarhan OR, Cerci C, Karaguzel N, Akdeniz Y, Bulbul M. Prognostic factors of peptic ulcer perforation. Saudi Med J. 2005;26:1255-9.
Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33:80-5.
Larkin JO, Bourke MG, Muhammed A, Waldron R, Barry K, Eustace PW. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study. Ir J Med Sci. 2010;179:545-9.
Scott HW, Sawyers JL, Gobbel WG, Herrington JL. Definitive surgical treatment in duodenal ulcer disease. Curr Probl Surg. 1987;1:56.
Testini M, Portincasa P, Piccinni G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol. 2003;9:2338-40.
Schein M. Perforated peptic ulcer. In: Schein M, Rogers PN, eds. Schein’s common sense emergency abdominal surgery, 2nd edn., Berlin Heidelberg: Springer-Verlag 2004;143-50.
