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Godefroy NB, Muhumuza J, Molen SF, Waziri MA, Kagenderezo BP, Vahwere BM, Sikakulya FK, Mauricio W, Wandabwa J, Francois BK, Agwu E, Okedi XF. Bacterial profile and antibiotic susceptibility patterns in patients with secondary peritonitis: a cross-sectional study in Uganda. Perioper Med (Lond) 2024; 13:62. [PMID: 38915124 PMCID: PMC11197276 DOI: 10.1186/s13741-024-00425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Secondary peritonitis is the second leading cause of sepsis worldwide. Drug resistance to peritoneal cavity bacterial infection remains a public health threat, especially in resource-limited settings in Africa, including Uganda. This study aimed to determine the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. METHODS This was a cross-sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. Clinical samples were aseptically collected at laparotomy from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. RESULTS The majority of the patients were males (61.9%) with a mean age of 37.9(SD ± 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organisms at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570-8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95% CI = 1.232-7.099, p = 0.015) were independently associated with secondary peritonitis. CONCLUSION Imipenem, Amikacin, Ciprofloxacin, and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital to minimize progression to secondary peritonitis.
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Affiliation(s)
- Nyenke Bassara Godefroy
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
| | - Selamo Fabrice Molen
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Musa Abbas Waziri
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Department of General Surgery, State Specialist Hospital, Borno State, Shehu Laminu Way, P.M.B, Maiduguri, 1014, Nigeria
| | - ByaMungu Pahari Kagenderezo
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Bienfait Mumbere Vahwere
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Frank Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - William Mauricio
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Joel Wandabwa
- Department of Surgery, Hoima Regional Referral Hospital, Hoima, Uganda
| | - Bisingurege Kagoro Francois
- Department of Internal Medicine, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Ezera Agwu
- Department of Microbiology, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Xaviour Francis Okedi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
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Okidi R, Sambo VDC, Okello I, Ekwem DA, Ekwang S, Obalim F, Kyegombe W. Associated factors of mortality and morbidity in emergency and elective abdominal surgery: a two-year prospective cohort study at lacor hospital, Uganda. BMC Surg 2024; 24:144. [PMID: 38730310 PMCID: PMC11088035 DOI: 10.1186/s12893-024-02433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The mortality rate associated with open abdominal surgery is a significant concern for patients and healthcare providers. This is particularly worrisome in Africa due to scarce workforce resources and poor early warning systems for detecting physiological deterioration in patients who develop complications. METHODS This prospective cohort study aimed to follow patients who underwent emergency or elective abdominal surgery at Lacor Hospital in Uganda. The participants were patients who underwent abdominal surgery at the hospital between April 27th, 2019 and July 07th, 2021. Trained research staff collected data using standardized forms, which included demographic information (age, gender, telephone contact, and location), surgical indications, surgical procedures, preoperative health status, postoperative morbidity and mortality, and length of hospital stay. RESULTS The present study involved 124 patients, mostly male, with an average age of 35 years, who presented with abdominal pain and varying underlying comorbidities. Elective cases constituted 60.2% of the total. The common reasons for emergency and elective surgery were gastroduodenal perforation and cholelithiasis respectively. The complication rate was 17.7%, with surgical site infections being the most frequent. The mortality rate was 7.3%, and several factors such as preoperative hypotension, deranged renal function, postoperative use of vasopressors, and postoperative assisted ventilation were associated with it. Elective and emergency-operated patients showed no significant difference in survival (P-value = 0.41) or length of hospital stay (P-value = 0.17). However, there was a significant difference in morbidity (p < 0.001). CONCLUSION Cholelithiasis and gastroduodenal perforation were key surgical indications, with factors like postoperative ventilation and adrenaline infusion linked to mortality. Emergency surgeries had higher complication rates, particularly surgical site infections, despite similar hospital stay and mortality rates compared to elective surgeries.
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Affiliation(s)
- Ronald Okidi
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda.
- Faculty of Medicine, Gulu University, Gulu, Uganda.
| | | | - Isaac Okello
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | | | - Solomon Ekwang
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | - Fiddy Obalim
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda
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Muhumuza J, Molen SF, Mauricio W, La O JS, Atumanyire J, Godefroy NB, Waziri MA, Kithinji SM, Sonye KM, Leocadie MM, Sikakulya FK, Kagenderezo BP, Lionel MS, Farah M, Lule H. Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial. Int J Surg Protoc 2023; 27:9-17. [PMID: 36818423 PMCID: PMC9912851 DOI: 10.29337/ijsp.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background Prolonged post-operative ileus is associated with increased risk of other complications, length of hospital stays and health care related costs. Chewing gum has been shown to reduce duration of ileus in many elective surgeries, but there is a paucity of randomised controlled trials (RCTs) on its effect on duration of ileus among patients undergoing emergency surgery, specifically patients with peritonitis. The aim of this study is to determine the effect of chewing gum on duration of postoperative ileus following laparotomy for gastroduodenal perforations. Methods This will be a randomised controlled trial done in 3 hospitals. Fifty-two patients will be randomised to 2 groups. Group A will receive chewing gum in addition to routine care, whereas group B will receive routine care only. The duration of post-operative ileus in the two groups which is the primary outcome, will be compared using the independent samples t-test in SPSS version 22. The length of hospital stay, in-hospital morbidity and mortality will be the secondary outcomes. This trial has been approved by Kampala International University research and Ethics committee (Ref No. KIU-2021-60) and Uganda national council of science and technology (Ref No. HS1665ES). Retrospective registration with the research registry has also been done (UIN: researchregistry8565). Highlights Prolonged post-operative ileus significantly contributes to adverse surgical outcomesChewing gum has been shown to reduce duration of ileus in many elective surgeriesThere is paucity of RCTs on role of chewing gum following surgery for peritonitis.
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Affiliation(s)
- Joshua Muhumuza
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Selamo Fabrice Molen
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - William Mauricio
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Jorge Soria La O
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Jethro Atumanyire
- Faculty of Medicine and dentistry, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Nyenke Bassara Godefroy
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Musa Abbas Waziri
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda,State Specialist Hospital (HMB), Department of Surgery. Maiduguri, Borno State Nigeria
| | - Stephen Mbae Kithinji
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Kiyaka Magugu Sonye
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Mugisho Munyerenkana Leocadie
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Franck Katembo Sikakulya
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda,Faculté de médecine, Université Catholique du Graben, Butembo, RDC
| | - ByaMungu Pahari Kagenderezo
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Musafiri Simba Lionel
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Mumin Farah
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Herman Lule
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda,Department of Clinical Medicine, Division of Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland
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Iranya RN, Mbiine R, Semulimi AW, Nasige J, Makumbi T, Galukande M. Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in-hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study. BMC Surg 2022; 22:291. [PMID: 35902850 PMCID: PMC9331107 DOI: 10.1186/s12893-022-01743-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background The majority of the prognostic scoring tools for peritonitis are impractical in low resource settings because they are complex while others are quite costly. The quick Sepsis-related Organ Failure Assessment (qSOFA) score and the Physiologic Indicators for Prognosis in Abdominal Sepsis (PIPAS) severity score are two strictly bedside prognostic tools but their predictive ability for mortality of peritonitis is yet to be compared. We compared the predictive ability of the qSOFA criteria and the PIPAS severity score for in-hospital mortality of peritonitis. Method This was a prospective cohort study on consecutive peritonitis cases managed surgically in a tertiary hospital in Uganda between October 2020 to June 2021. PIPAS severity score and qSOFA score were assessed preoperatively for each case and all cases were then followed up intra- and postoperatively until discharge from the hospital, or up to 30 days if the in-hospital stay was prolonged; the outcome of interest was in-hospital mortality. We used Receiver Operating Characteristic curve analysis to assess and compare the predictive abilities of these two tools for peritonitis in-hospital mortality. All tests were 2 sided (p < 0.05) with 95% confidence intervals. Results We evaluated 136 peritonitis cases. Their mean age was 34.4 years (standard deviation = 14.5). The male to female ratio was 3:1. The overall in-hospital mortality rate for peritonitis was 12.5%. The PIPAS severity score had a significantly better discriminative ability (AUC = 0.893, 95% CI 0.801–0.986) than the qSOFA score (AUC = 0.770, 95% CI 0.620–0.920) for peritonitis mortality (p = 0.0443). The best PIPAS severity cut-off score (a score of > = 2) had sensitivity and specificity of 76.5%, and 93.3% respectively, while the corresponding values for the qSOFA criteria (score > = 2), were 58.8% and 98.3% respectively. Conclusions The in-hospital mortality in this cohort of peritonitis cases was high. The PIPAS severity score tool has a superior predictive ability and higher sensitivity for peritonitis in-hospital mortality than the qSOFA score tool although the latter tool is more specific. We recommend the use of the PIPAS severity score as the initial prognostic tool for peritonitis cases in the emergency department. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01743-4.
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Affiliation(s)
| | - Ronald Mbiine
- Department of Surgery, School of Medicine, Makerere University, Kampala, Uganda
| | - Andrew Weil Semulimi
- Department of Physiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - Joan Nasige
- Department of Surgery, School of Medicine, Makerere University, Kampala, Uganda
| | - Timothy Makumbi
- Department of Surgery, School of Medicine, Makerere University, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, School of Medicine, Makerere University, Kampala, Uganda
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