scholarly journals Clinical evaluation of patient with perforation peritonitis and their peritoneal fluid analysis for culture and sensitivity

2018 ◽  
Vol 5 (6) ◽  
pp. 2296
Author(s):  
Rajiv Srivastava ◽  
Rajeev Kumar Singh
Keyword(s):  
Peritoneal Fluid ◽  
Gastric Perforation ◽  
Exploratory Laparotomy ◽  
Peptic Ulcer Perforation ◽  
Common Site ◽  
Gram Negative ◽  
Fluid Analysis ◽  
Perforation Peritonitis ◽  
Culture And Sensitivity ◽  
Acute Perforation

Background: Perforation peritonitis is one of the most common emergency that is encountered by surgical unit in emergency department and timely management of it can prevent morbidity and mortality, its important to reach the diagnosis earliest and intervene immediately. we find that understanding the peritoneal fluid obtained on exploratory laparotomy and knowing its culture and sensitivity and treating with appropriate antibiotic has a significant role in better management and early recovery of such patients.Methods: This study comprises of 100 consecutive cases of acute perforation peritonitis on whom exploratory laparotomy was done. In a study period from 1/4/2016 to 13/7/2017 conducted by department of General surgery Government medical college Haldwani-Nanital. Diagnosis was made on basis of clinical and radiological examination. Peritoneal fluid sample was obtained after opening the peritoneum and sent for peritoneal fluid analysis to microbiology department to get culture and sensitivity.Results: Male to female ratio was 3:1 and the most common age group involved was between 20 to 40 years. The most common site of perforation was found to be duodenum amounting to 55% of cases followed by ileal perforation found in 20% cases, gastric perforation was found in 10 % of case. Most common microorganism among Gram negative organism was Klebsella found in 52% cases followed by E. coil in 36% cases, both were found together in 5% cases in rest of the cases proteus and pseudomonas were found. Sensitivity was found to ceftrioxone,ciprofloxacillin and amikacin in more than 87% of gram negative organism while resistance was seen to amplicillin and clotrimoxazole other antibiotics that showed sensitivity to microorganism were Linizoild and minocycline in 76% cases. Around 8% fluid showed presence of methecillin resistant or sensitive Staphylococcus aureus and both were sensitive to linizoilid and minocycline and resistant to penicillin, erythromycin and cephxatin.Conclusions: Peptic ulcer perforation is found to be most common site of perforation where second part of the duodenum supersedes Gastric perforation ratio been 5:1 jointly they are responsible for 65% of perforations. Second most common cause of perforation was due to enteric fever causing ilial perforation which was seen in 20% of the cases. Most common microorganism found is Klebsella and E. coli found in almost 81% of the case and were found to be sensitive to ceftrioxone, amikacin, linizoild and minocycline in almost all the cases.

scholarly journals Peritonitis due to Moraxella Osloensis: An Emerging Pathogen

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Sreedhar Adapa ◽  
Purva Gumaste ◽  
Venu Madhav Konala ◽  
Nikhil Agrawal ◽  
Amarinder Singh Garcha ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Healthcare Providers ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Detection Techniques ◽  
Fluid Analysis ◽  
Moraxella Osloensis ◽  
Gram Negative Organisms ◽  
Fluid Culture

Peritonitis is a very serious complication encountered in patients undergoing peritoneal dialysis and healthcare providers involved in the management should be very vigilant. Gram-positive organisms are the frequent cause of peritonitis compared to gram-negative organisms. There has been recognition of peritonitis caused by uncommon organisms because of improved microbiological detection techniques. We report a case of peritonitis caused by Moraxella osloensis (M. osloensis), which is an unusual cause of infections in humans. A 68-year-old male, who has been on peritoneal dialysis for 2 years, presented with abdominal pain and cloudy effluent. Peritoneal fluid analysis was consistent with peritonitis and peritoneal fluid culture grew gram-negative bacteria. M. osloensis was identified by 16 S PCR phenotypic and sequencing techniques. Patient responded well to the treatment, with intraperitoneal cephalosporin, and repeat peritoneal fluid culture yielded no growth. M. osloensis rarely causes infection in humans and responds well to treatment, as reported in literature.

scholarly journals Ultrasonography and surgery of canine biliary diseases

2001 ◽  
Vol 49 (2) ◽  
pp. 141-154 ◽  
Author(s):  
K. Vörös ◽  
T. Németh ◽  
T. Vrabély ◽  
F. Manczur ◽  
J. Tóth ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Peritoneal Fluid ◽  
Normal Liver ◽  
Exploratory Laparotomy ◽  
Bile Peritonitis ◽  
Intestinal Volvulus ◽  
Fluid Analysis ◽  
Small Intestinal ◽  
Bile Sludge ◽  
Gallbladder Rupture

Findings of hepatic and gallbladder ultrasonography were analyzed in 12 dogs with gallbladder and/or extrahepatic biliary tract obstruction and compared with the results of exploratory laparotomy. Hepatic ultrasonography demonstrated normal liver in 2 dogs and hepatic abnormalities in 10 animals. The following ultrasonographic diagnoses were established compared to surgical findings: gallbladder obstruction caused by bile sludge (correct/incorrect: 1/2, surgical diagnosis: choleliths in one case), gallbladder obstruction caused by neoplasm (0/1, surgical diagnosis: mucocele), gallbladder and extrahepatic biliary tract obstruction due to choleliths (3/3), extrahepatic biliary tract obstruction caused by pancreatic mass (1/1) and small intestinal volvulus (1/1). Bile peritonitis caused by gallbladder rupture (4/4) was correctly diagnosed by ultrasound, aided with ultrasonographically-guided abdominocentesis and peritoneal fluid analysis. Rupture of the gallbladder should be suspected in the presence of a small, echogenic gallbladder or in the absence of the organ together with free abdominal fluid during ultrasonography. Laparotomy was correctly indicated by ultrasonography in all cases. However, the direct cause of obstruction could not be determined in 2 of the 12 dogs by ultrasonography alone.

scholarly journals Peritonitis from facultative anaerobic gram-negative bacilli likely due to translocation of bacteria from gut in a patient undergoing peritoneal dialysis

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Sreedhar Adapa ◽  
Srikanth Naramala ◽  
Harmandeep Singh Tiwana ◽  
Niraj Patel ◽  
Raman Verma ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Healthcare Providers ◽  
High Morbidity ◽  
Peritoneal Dialysis Catheter ◽  
Gram Negative ◽  
Detection Techniques ◽  
Fluid Analysis ◽  
Gram Negative Organisms ◽  
Oral Ciprofloxacin

The peritonitis caused by gram-negative organisms is a serious complication encountered in patients undergoing peritoneal dialysis, often causing high morbidity and mortality. There has been recognition of peritonitis caused by uncommon organisms because of improved microbiological detection techniques. The healthcare providers involved in the management of these patients should be very vigilant. We report a rare case of peritonitis caused bycA 42-year-old male on peritoneal dialysis for five years presented with abdominal pain and cloudy effluent. The peritoneal fluid analysis was consistent with peritonitis, and peritoneal fluid culture grew Citrobacter freundii. The patient was treated with two courses of double antibiotic coverage with intraperitoneal ceftazidime and oral ciprofloxacin, which failed to resolve the infection and hence resulted in the removal the peritoneal dialysis catheter and dialysis modality change.

scholarly journals Perforation Peritonitis and the Developing World

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Rajandeep Singh Bali ◽  
Sushant Verma ◽  
P. N. Agarwal ◽  
Rajdeep Singh ◽  
Nikhil Talwar
Keyword(s):  
Peptic Ulcer ◽  
Single Unit ◽  
Tertiary Care ◽  
Exploratory Laparotomy ◽  
Gastric Ulcers ◽  
Peptic Ulcer Perforation ◽  
Care Hospital ◽  
Duodenal Ulcers ◽  
Ulcer Disease ◽  
Perforation Peritonitis

Background. Perforation peritonitis is the one of the commonest emergency encountered by surgeons. The aim of this paper is to provide an overview of the spectrum of perforation peritonitis managed in a single unit of a tertiary care hospital in Delhi. Methods. A retrospective study was carried out between May 2010 and June 2013 in a single unit of the department of Surgery, Lok Nayak Hospital, Delhi. It included 400 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included. Results. The commonest cause of perforation peritonitis included 179 cases of peptic ulcer disease (150 duodenal ulcers and 29 gastric ulcers) followed by appendicitis (74 cases), typhoid fever (48 cases), tuberculosis (40 cases), and trauma (31). The overall mortality was 7%. Conclusions. Perforation peritonitis in India has a different spectrum as compared to the western countries. Peptic ulcer perforation, perforating appendicitis, typhoid, and tubercular perforations are the major causes of gastrointestinal perforations. Early surgical intervention under the cover of broad spectrum antibiotics preceded by adequate aggressive resuscitation and correction of electrolyte imbalances is imperative for good outcomes minimizing morbidity and mortality.

scholarly journals Emergency Surgery during COVID-19: Lessons Learned

2020 ◽  
Vol 06 (03) ◽  
pp. e167-e170
Author(s):  
Hemanga K. Bhattacharjee ◽  
Shafneed Chaliyadan ◽  
Eshan Verma ◽  
Keerthi Kumaran ◽  
Priyank Bhargava ◽  
...  
Keyword(s):  
Stable Condition ◽  
Exploratory Laparotomy ◽  
Sigmoid Volvulus ◽  
Lessons Learned ◽  
Suspected Case ◽  
Surgical Emergencies ◽  
Viral Particles ◽  
Hospital Patients ◽  
Perforation Peritonitis ◽  
Precautionary Measures

Abstract Introduction The ongoing coronavirus disease-2019 (COVID-19) pandemic has disrupted health services throughout the world. It has brought in several new challenges to deal with surgical emergencies. Herein, we report two suspected cases of COVID-19 that were operated during this “lockdown” period and highlight the protocols we followed and lessons we learned from this situation. Result Two patients from “red zones” for COVID-19 pandemic presented with acute abdomen, one a 64-year male, who presented with perforation peritonitis and another, a 57-year male with acute intestinal obstruction due to sigmoid volvulus. They also had associated COVID-19 symptoms. COVID-19 test could not be done at the time of their presentation to the hospital. Patients underwent emergency exploratory laparotomy assuming them to be positive for the infection. Surgical team was donned with full coverall personal protective equipment. Sudden and uncontrolled egression intraperitoneal free gas was avoided, Echelon flex 60 staplers were used to resect the volvulus without allowing the gas from the volvulus to escape; mesocolon was divided using vascular reload of the stapler, no electrosurgical devices were used to avoid the aerosolization of viral particles. Colostomy was done in both the patients. Both the patients turned out to be negative for COVID-19 subsequently and discharged from hospital in stable condition. Conclusion Surgeons need to adapt to safely execute emergency surgical procedures during this period of COVID-19 pandemic. Preparedness is of paramount importance. Full precautionary measures should be taken when dealing with any suspected case.

#58: Improving the Peritoneal Dialysis Program in a Pediatric hospital in Honduras Using Six Sigma Methodology

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Sara Eloisa Rivera Molina ◽  
Claudia Romero Quiroz ◽  
Dilcia Sauceda Acosta
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Six Sigma ◽  
Peritoneal Fluid ◽  
Dwell Time ◽  
Clinical Signs ◽  
Pediatric Hospital ◽  
Gram Negative ◽  
Six Sigma Methodology ◽  
Fluid Cell

Abstract Background Peritoneal dialysis (PD) is the most common method of renal replacement therapy (RRT) in pediatric patients in Honduras. It has improved survival and quality of life. Unfortunately, there are complications associated with the use of PD catheters, 85% of which, are of infectious origin. These infections carry a high burden of morbidity and mortality, lengthen hospital stays, and increase costs and are a motive for transfer to hemodialysis. Hospital María Especialidades Pediátricas (HMEP) is a pediatric hospital caring for patients with chronic kidney disease in Honduras, PD has been offered as a method for RRT since September 2014. Methods In HMEP, monitoring of PD infection rates through active surveillance began December 1, 2017, as the first step (define and measure) toward the improvement of the PD Program based on Six Sigma methodology. A case of peritonitis was diagnosed when at least 2 of the following 3 criteria were met: (1) Clinical signs or symptoms of peritonitis (cloudy effluent or abdominal pain with fever or vomiting); (2) Altered peritoneal fluid cell count (after a dwell time of 2 hours: a WBC above 100 cells/mm3 in an uncentrifuged sample, with at least 50% neutrophils; or any WBC count with at least 50% neutrophils if the dwell time was less than 2 hours); (3) Positive peritoneal fluid culture. Patient data, risk factors for infection, causative organisms, and event outcomes were recorded. We present the main results of the analysis phase of all peritonitis cases using descriptive statistics. Results From December 1, 2017, through November 30, 2019, 79 patients required PD, representing 8931 catheter-days; and 30 peritonitis episodes occurred among 28 individuals (35%). The peritonitis rate during the 2-year surveillance period was 1.2 infections per patient-years (ideally: <0.67). Twenty-seven (90%) of cases were classified as healthcare associated since these patients underwent PD 3 times a week in the hospital and the catheter was only manipulated by medical staff; the other patients received dialysis at home. The median time from catheter placement to the event was 27 days (5–383 days). All patients had clinical signs or symptoms of peritonitis. Peritoneal fluid cell count results were available for 29 infections, all of which reported altered results. Peritoneal fluid cultures were positive in only 12 events (40%); 6 (50%) reported Gram-negative organisms, 5 (41%) reported Gram-positive and 1 reported Aspergillus spp. Nonfermentative Gram-negative bacteria (Pseudomonas aeruginosa and Acinetobacter lwoffii) were the most common organisms identified; Staphylococcus epidermidis was the most common Gram-positive. Ten events (33%) required removal and replacement of the catheter due to the infection, 6 (20%) required permanent transfer to hemodialysis; 2 (7.1%) patients experienced a relapse. Two (7.1%) died due to infection. Conclusions Implementing Six Sigma methodology allowed us to improve our PD Program by objectively quantifying the magnitude of the problem and identifying risk factors. This supported the infection prevention and control team with the implementation and improvement of preventive measures: change in hand hygiene products (from triclosan to chlorhexidine), increasing hand hygiene compliance, improving connection/disconnection procedure, PD catheter insertion, and maintenance, empowerment of caregivers.

scholarly journals THE STUDY OF MULTIDRUG-RESISTANCE IN NEONATAL INTENSIVE CARE UNIT AT THE CENTRAL JAVA HOSPITAL

2017 ◽  
Vol 10 (14) ◽  
pp. 80 ◽  
Author(s):  
Ika Puspita Sari ◽  
Titik Nuryastuti ◽  
Djoko Wahyono
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistance ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Central Java ◽  
Culture And Sensitivity

Objective: Multidrug-resistance (MDR) is defined as an acquired non-susceptibility to at least one agent in three or more antimicrobial categories. MDR can be caused by several factors, including the misuse of antibiotics.  Resistance to antibiotics still poses a global challenge, especially in Indonesia. This study aimed to identify patterns of MDR in Neonatal Intensive Care Unit (NICU) at the Central Java Hospital, during the period of January 2014 to December 2015.Methods: The study was conducted using a descriptive retrospective design. The research population comprised of 225 patients. Patient inclusion criteria were neonatal patients treated in NICU ward with infection diagnosis. All patients had culture and sensitivity examinations on their bloods. The culture and sensitivity examinations were performed by microbiology clinicians.Results: The most common infection type was sepsis (60%). The most common bacteria found in the blood specimen of patients in the NICU ward was Gram-negative bacteria with a 72% rate, the other was Gram-positive bacteria. Bacteria which infected patients include; Klebsiellapneumoniaessppneumoniae, Pseudomonas aeruginosa, Bulkholderiacepacia, Acinetobacterbaumannii, Enterobactercloacae ssp cloacae, Serratiamarcescens, Staphylococcus haemolyticusand Staphylococcus epidermidis. The research result showed that 97.8% MDR cases were reported in the NICU ward. Antibiotics which were still potent for all bacteria found in NICU patients were tigecycline, meropenem and ciprofloxacin (for Gram-negative bacteria) and tigecycline, linezolid, nitrofurantoin, moxifloksacin and vancomycin (for Gram-positive bacteria).Conclusion: A high percentage of MDR occurred in NICU patients. Sepsis is the most common diagnosis in NICU patients. The usage of third generation antibiotics should be limited and regulated systematically.   

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