Studying the microbial landscape of peritoneal exudate in acute diffuse purulent peritonitis

Abstract

Aim. To study current trends in changing microbial landscape of peritoneal exudate for improving treatment outcomes, as well as the generalization of the methods of predicting fatal outcomes of postoperative peritonitis, its etiological and pathogenetic treatment.Methods. A bacteriological study of peritoneal exudate in 60 patients with purulent peritonitis at toxic and terminal phases, who were treated in the department of purulent surgery, and their comparison with the results obtained 10 years ago were performed. Laboratory testing was performed, APACHE II (Acute Physiology And Chronic Health Evaluation - scale for the evaluation of various acute and chronic diseases), Mannheim peritoneal index, albumin-globulin ratio, leukocyte index of intoxication were calculated.Results.During the 10-year period change in the microbial landscape of peritoneal exudate in patients with postoperative peritonitis was registered, with a statistically significant decrease in representation of Enterobacter, Staphylococcus, Escherichia coli, Pseudomonas aeruginosa bacteria, and increase in representation of Streptococci, Enterococci and anaerobic gram-negative cocci, Citrobacter, Klebsiella. Study results of microflora sensitivity to antibiotics showed that the vast majority (over 90%) of peritoneal infection pathogens has full or partial resistance to all antibiotics; antimicrobial effect increased in case of combined treatment using two or three drugs with a synergistic effect. With a decrease in the albumin-globulin ratio by 0.1 from 1.5 the mortality rate increased by 5-10%, and in patients with multiple organ failure was doubled (pConclusion. Prediction of postoperative peritonitis, complications and outcomes allows their timely prevention and treatment; basic conditions of preventing peritonitis are primary qualitative debridement of the abdominal cavity, the right choice of surgical volume, starting adequate antibiotic therapy, qualified perioperative anesthetic management and a complex of adequate pathogenetic treatment.