Role of enteric fever in ileal perforations: an overstated problem in tropics?
OBJECTIVE
To determine the role of enteric fever in ileal perforations.


METHODS
A prospective cohort of 47 patients of ileal perforation was subjected to clinical examination and investigations for APACHE II scoring. Blood, ulcer edge biopsy, mesenteric lymph node and peritoneal aspirate were subjected to culture to determine the predominant aerobic bacterial isolate and its antibiogram.


RESULTS
Seven patients (14.9%) required intensive care and seven (14.9%) developed septicaemia. Mortality was 17%. Highest isolation rate was seen in ulcer edge (70.2%) followed by lymph node (66%) culture. The bacterial spectrum was Escherichia coli (23.4%), Enterococcus faecalis (21.3%), Salmonella enterica serovar Typhi (6.3%), Salmonella enterica serovar Paratyphi A (4.2%), etc.


CONCLUSIONS
Enteric fever organisms are not the predominant causative agents of ileal perforations. Culture of ulcer edge biopsy, lymph node is crucial for aetiological diagnosis. The use of APACHE II triaging and prescription of antimicrobials based on the local pattern of susceptibility profile of the aetiological agent is recommended.
Capoor
M R
MR
Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India.
Nair
D
D
Chintamani
M S
MS
Khanna
J
J
Aggarwal
P
P
Bhatnagar
D
D
D018806:APACHE; D000293:Adolescent; D000328:Adult; D001769:Blood / Q000382:microbiology; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000382:microbiology*; D007416:Intestinal Perforation / Q000382:microbiology*; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000382:microbiology; D018805:Sepsis / Q000382:microbiology; D014456:Ulcer / Q000382:microbiology