Aetiology, Microbial Agents, and Sensitivity Patterns of Peritonitis Patients Operated at Kilimanjaro Christian Medical Centre, Northern Tanzania
DOI:
https://doi.org/10.66354/rpq6fb98Keywords:
Peritonitis, microbial agents, sensitivity and laparotomy, northern TanzaniaAbstract
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.
References
Yesuf M, Taye M, Bogale E. Treatment Outcomes of Non-Traumatic Acute Abdomen and Its Associated Factors in Adult Patients at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia: Cross-Sectional Study. Open Access Surg. 2023;Volume 16(December):105–13.
Hamadi H, Mbena H, Kiritta RF, Ottomah O, Vitus S, Mirambo MM, et al. Factors Associated with Short-Term Surgical Outcomes Among Women Presenting with Pelvic Peritonitis at Bugando Medical Centre Mwanza, Tanzania. East African Heal Res J. 2023;7(2):147–57.
Msuya ND, Aloyce JP, Msuya D, Chilonga K, Herman A, Chugulu S. Prognostic Indicators and Short Term Outcomes for Operated Patients with Peritonitis: Prospective Cohort Hospital Based Study in Northern Tanzania. J Surg Open Access. 2021;7(3):1–9.
Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, et al. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg [Internet]. 2024;19(23):1–36. Available from: https://doi.org/10.1186/s13017-024-00551-w
Salam A, Al-Amin Y, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare. 2023;11(1946):1–20.
Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals. 2023;16(11):1–54.
Diop M, Bassoum O, Ndong A, Wone F, Ghogomu Tamouh A, Ndoye M, et al. Prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa: systematic review and meta-analysis. BMC Infect Dis. 2025;25(1).
Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg. 2021;110(2):139–49.
Donà D, Barbieri E, Brigadoi G, Liberati C, Bosis S, Castagnola E, et al. State of the Art of Antimicrobial and Diagnostic Stewardship in Pediatric Setting. Antibiotics. 2025;14(2):1–31.
Bach N, Chi TTK, Trung LC, Ngoc NHB, Hoa TPT, Huynh TNP, et al. Prevalence, microbiology, and outcome of peritonitis in peritoneal dialysis patients in vietnam: a multicenter study. BMC Nephrol. 2025;26(134):1–10.
Jean Paul A, Toussaint S, Alouidor J. Descriptive and correlational study of peritonitis in the surgical department of the State University hospital of Haïti (HUEH): A cross sectional study. Int J Surg Open [Internet]. 2020;24(2020):105–11. Available from: https://doi.org/10.1016/j.ijso.2020.05.001
Howell EC, Dubina ED, Lee SL. Perforation risk in pediatric appendicitis: Assessment and management. Pediatr Heal Med Ther. 2018;9:135–45.
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(27):1–42.
Maghbool M, Samizadeh B, Ramezanipour S. Acute peritonitis caused by a giant appendicolith: A rare case report and a literature review. Int J Surg Case Rep [Internet]. 2025;129(January):111198. Available from: https://doi.org/10.1016/j.ijscr.2025.111198
Huang CH, Lee CH, Chang C. Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis—A Literature Review. Livers. 2022;2:214–32.
Karachentsev S. Epidemiology and management of peritonitis at a rural hospital in Zambia. Ann African Surg. 2020;17(3):120–5.
Basavarahu M, Gunashree BS. Escherichia coli: An Overview of Main Characteristics. Intech [Internet]. 2022;i:1–22. Available from: https://doi.org/10.5772/intechopen.105508
Al Dabbagh M, Alghounaim M, Almaghrabi RH, Dbaibo G, Ghatasheh G, Ibrahim HM, et al. A Narrative Review of Healthcare-Associated Gram-Negative Infections Among Pediatric Patients in Middle Eastern Countries. Infect Dis Ther [Internet]. 2023;12:1217–35. Available from: https://doi.org/10.1007/s40121-023-00799-w
Inoue M, Kako E, Kinugasa R, Sano F, Iguchi H, Sobue K. Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report. JA Clin Reports. 2019;5(29):1–6.
Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Vol. 11, Microorganisms. 2023. 1–32 p.
Mnyambwa NP, Mahende C, Wilfred A, Sandi E, Mgina N, Lubinza C, et al. Antibiotic susceptibility patterns of bacterial isolates from routine clinical specimens from referral hospitals in tanzania: A prospective hospital-based observational study. Infect Drug Resist. 2021;14:869–78.
Giubelan LI, Neacșu AI, Rotaru-Zavaleanu AD, Osiac E. Antimicrobial Resistance in Sepsis Cases Due to Escherichia coli and Klebsiella pneumoniae: Pre-Pandemic Insights from a Single Center in Southwestern Romania. Healthcare. 2024;12(1713):1–13.
Kitaba AA, Bonger ZT, Beyene D, Ayenew Z, Tsige E, Kefale TA, et al. Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia. Afr J Lab Med. 2024;13(1):1–7.
Mohammad AS. Antimicrobial susceptibility of Escherichia coli isolates from clinical specimens in children over a 5-year period in Jordan. Biomed Pharmacol J. 2016;9(1):9–13.
Ayatollahi J, Sharifyazdi M, et al. Antibiotic resistance pattern of Klebsiella pneumoniae in obtained samples from Ziaee Hospital of Ardakan, Yazd, Iran during 2016 to 2017. Iberoam J Med. 2020;2(2):32–6.
Wood SJ, Kuzel TM, Shafikhani SH. Pseudomonas aeruginosa: Infections, Animal Modeling, and Therapeutics. Cells [Internet]. 2023;12(1–37):191–204. Available from: http://dx.doi.org/10.1016/B978-0-12-809880-6.00013-8
Kengne M, Fotie HBN, Nwobegahay JM, Achiangia PN, Tamoufe U, Goon D Ter, et al. Antibiotic sensitivity profile of staphylococcus aureus isolated from hiv/aids patients presenting with pyoderma, at the yaounde central hospital, cameroon. Pan Afr Med J. 2020;37(185):1–8.
Hernández RB, Juliá MB. Enterococcus spp. and Streptococcus spp. bloodstream infections: epidemiology and therapeutic approach. Rev Esp Quimioter. 2023;36:2–4.
Altaf U, Saleem Z, Akhtar MF, Altowayan WM, Alqasoumi AA, Alshammari MS, et al. Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan. Medicina (B Aires). 2023;59(1237):1–18.