http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-2.xsd
Secondary bacterial peritonitis in patan hospital
ABSTRACT: Background: Secondary bacterial peritonitis. one of the common surgical emergencies caries high mortality. Since it includes heterogenous disease some form of stratification is necessary for the assessment of severity of disease and prognosis. The aim of this study was to evaluate the prognosis of our patients in terms of APACHE II and Mannheim peritonitis index and study the microbiological profile in the setting of the District General Hospital in the capital city of Nepal. Method: This is prospective observational study performed between January and September 1999 in 40 patients (male:female 27.13) who were operated for secondary bacterial peritonits at the Department of Surgery Patan Hospital. Data was collected in a earlier made proforma. The outcome in terms of mortality were compared for different variables and the microbiological culture sensitivity results were noted. Results: Age ranged from 10 to 74 year with a mean of 4.16 year. Perforated duodenal ulcer occurred in 18 (45%), traumatic perforation in 3(7.5%) and tubercular ileal perforation in 2(5%). Source of perforation could not be detected in 4(10%). Duration of presentation ranged from 4 hours to 2 weeks from the onset of pain. Gas below the diaphragm was observed in 13 of the 19 duodenal ulcer perforations. Postoperative complications occurred in 54% of the patients. Altogether 5 patients died during the postoperative period; 3 with perforated duodenal ulcer and 2 with ileal perforation. The APACHE II score ranged from 1-26 with a mean of 15.45. The APACHE II less than 15 had 2.94% mortality compared to 66% for those above 15 (P = 0.0007). The Mannheim peritonitis index < 26 had 0% mortality were age <55vs>55 ((P = 0.0007), preoperative organ impairment (P = 0.0017), duration of peritonitis <24 hours vs >24 hours (P = 0.013). The number of deaths increased as the number of failed organs increased (P =0.0001). Microbiological reports were available in only 35 patients. Fifteenorganisms were grown in 12 patients. Escherechia coli, streptococcus and Klebsiella accounted for 7, 5 and 3 organisms respectively. All E coli were sensitive to gentamicin in contrast to ciprofloxacin and cefotaxime to which some strains were resistant. All streptococci were sensitive to amoxicillin. Conclusions: APACHE II and Mannheim peritonitis index were reliable predictors of outcome in peritonitis patients. Wider application of the ICU measures and early interventions would be helpful to reduce the mortality in these patients.