A clinico-microbiological profile in patients with perforated peptic ulcer with special reference to anaerobic organisms: a descriptive study

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 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.