title: Epidemiology and Microbiology of Secondary Peritonitis Caused by Viscus Perforation: A Single-Center Retrospective Study.
abstract: BACKGROUND
  Complicated intra-abdominal infections are serious conditions that require urgent source control and antibiotic treatment. The purpose of this study was to evaluate the epidemiology and bacterial causation of such infections using blood and peritoneal cultures of Korean patients with peritonitis originating from viscus perforation.
  
  
  METHODS
  The medical records of 419 consecutive patients who underwent emergency surgery because of bowel perforation from January 2007 to December 2011 were analyzed. Clinical characteristics, peri-operative conditions, perforation sites, and mortality data were obtained. Bacterial distributions and antibiotic resistance were evaluated using blood and peritoneal culture reports.
  
  
  RESULTS
  The most common perforation site was the colon (165; 39.4%), and the overall mortality rate was 11.2%. Blood cultures were performed in 182 patients, and 20 patients (11.0%) had a positive culture. Blood culture positivity was significantly higher for colon perforations (17.7%) than perforations elsewhere (p=0.039). A peritoneal culture was performed for each of 210 patients (50.1%), and 145 of those patients (69.0%) had a positive culture. Enterococcus faecium (35.2%) was the most common gram-positive bacterium, and Escherichia coli was the most common gram-negative organism. There were 276 community-acquired infections (CAI) (65.9%) and 143 hospital-acquired infections (HAI) (34.1%). Escherichia coli producing extended-spectrum β-lactamases were more common in the HAI than in the CAI group (p=0.016).
  
  
  CONCLUSIONS
  The compositions and antibiotic resistances of micro-organisms found in this study are similar to those reported previously. A multicenter prospective study is needed of this disease state in South Korea.
authors.affiliation: 1 Department of Surgery, Yonsei University Wonju College of Medicine , Wonju, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: 2 Departments of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: 1 Department of Surgery, Yonsei University Wonju College of Medicine , Wonju, Republic of Korea.
authors.forename: Hongjin
authors.initials: H
authors.lastname: Shim
authors.affiliation: 4 Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.affiliation: 3 Laboratory Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Dongeun
authors.initials: D
authors.lastname: Yong
authors.affiliation: 2 Departments of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Jae Gil
authors.initials: JG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D017714:Community-Acquired Infections; D003428:Cross Infection; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents