Outcome of intra-operative Purulent Peritoneal Fluid Aspirate Culture Results during Appendicectomy in Patients’ Management

Abstract

Background: Intra-operative purulent peritoneal fluid aspirate for microscopy, culture, and sensitivity during appendicectomy is practiced by some surgeons to help in the post-operative management of patients if the patients get unwell, requiring a change of the prescribed pre-operative antibiotics.  This study aimed to evaluate if there are benefits from purulent peritoneal fluid aspirate culture results during appendicectomy.

Methodology: This was a retrospective review of medical records and operation notes of all the patients who had an appendicectomy with purulent peritoneal fluid that was aspirated for microscopy culture and sensitivity in the last 3 years (May 2019 to April 2022).

Results: A total of 73 patients had purulent peritoneal fluid culture results and received perioperative intravenous antibiotics. There were 52 (71%) bacteriological positive culture results from the purulent peritoneal fluid aspirates and 21 (29%) negative peritoneal pus culture results. The most common antibiotics administered were a combination of co-amoxiclav and metronidazole 45 (61.6%). One-quarter of the preoperative antibiotics were changed due to the positive microbiology culture results from the peritoneal pus aspirates. The main reasons for the change in antibiotics were intra-abdominal collections and wound infection in 21 (28.8%) of the patients, and Streptoccocus anginosus was the most common organism isolated. A re-operation and/or ultrasound-guided drainage of intra-abdominal collections were avoided in 13 out of 17 patients due to the change of the pre-operative antibiotics following the results from the purulent peritoneal fluid.

Conclusion: The intra-operative purulent peritoneal fluid culture results during appendicectomy contributed positively towards the post-operative management of patients.