Aetiology, microbial agents, and sensitivity patterns of peritonitis patients operated at Kilimanjaro Christian Medical Centre, Northern Tanzania

Abstract

Introduction: Peritonitis remains a significant cause of morbidity and mortality among surgical patients. Understanding its aetiology and antimicrobial susceptibility is essential for effective treatment. This study investigates the causative organisms, antimicrobial agents used, and sensitivity patterns among patients with peritonitis who underwent surgery at Kilimanjaro Christian Medical Centre in northern Tanzania.

Methods: A prospective hospital-based cross-sectional study was conducted at Kilimanjaro Christian Medical Centre (KCMC) from October 2015 to March 2016 on admitted patients. Peritoneal fluid (5-10) mls and aerobic culture using standard microbiological techniques was taken during the operation. Antibiotic sensitivity testing was conducted against locally available antibiotics using the disk diffusion method.

Results: A total of 60 patients with a median age of 22.5 and an interquartile range (IQR) of 12.0-44.5 were enrolled in this study, and the majority (65.0%) of them were males. Secondary peritonitis was the leading cause of peritonitis by 81.7%, mainly due to ruptured appendix (41.6%), gastric perforation (10.0%), jejunum perforation (10.0%), and ileal perforation (8.3%). Gram-negative bacteria were the most frequently isolated bacteria. Escherichia coli (38.2%) was the most frequently isolated bacterium, followed by coliform species (14.8%) and another Streptococcus pyogenes, Staphylococcus aureus, and Klebsiella pneumoniae, all of which were isolated by 11.8%. Most of the gram-negative bacteria were sensitive to Amikacin (100.0%), Gentamycin (72.7), and Ceftriaxone (54.5%). Gram-positive bacteria were sensitive of 100.0% of Vancomycin, clindamycin, and Ciprofloxacin. All bacteria isolated and tested for ampicillin were resistant.

Conclusion: The most common causes of secondary peritonitis at Kilimanjaro Christian Medical Centre (KCMC) are perforated appendix, gastroduodenal, and jejunal perforations. Gram-negative bacteria were isolated the most, and E. coli was the commonest. Effective antibiotics for gram-negative bacteria were Amikacin, Gentamycin, and Ceftriaxone, and for gram-positive bacteria were Vancomycin, Clindamycin, and Ciprofloxacin. All bacteria were resistant to Ampicillin.