Bacterial Pathogens and Antimicrobial Susceptibility Mapping among Adult Patients with Acute Suppurative Peritonitis

International Journal of Medicine and Medical Sciences | Vol. 16, No. 4, April 2026 | pp. 25–32

DOI: 10.46882/2026/IJMMS/160025

Original Research Article

Bacterial Pathogens and Antimicrobial Susceptibility Mapping among Adult Patients with Acute Suppurative Peritonitis

Elizabeth A. Cole¹, Moses Z. Tarawallie², Victoria N. Okoye¹*

¹Department of Medical Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

²Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

Acute suppurative peritonitis resulting from hollow viscus perforation is a critical emergency, with treatment increasingly complicated by the emergence of multidrug-resistant enteric pathogens. This prospective cross-sectional study identified the predominant bacterial pathogens and mapped their antimicrobial susceptibility profiles among adult patients undergoing emergency laparotomy for secondary peritonitis. Peritoneal fluid samples collected intraoperatively from 120 patients were cultured. Bacterial confirmation was achieved using standard automated methods, and susceptibility profiles were assessed using the disk diffusion technique. Significant bacterial growth was confirmed in 88.3% (106/120) of the specimens, displaying a polymicrobial infection rate of 34.0%. Escherichia coli was the most common isolate (42.5%), followed by Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.1%), and Bacteroides fragilis (11.3%). Antibiogram mapping revealed high resistance rates among Gram-negative isolates to amoxicillin-clavulanic acid (84.9%) and ceftriaxone (72.6%). Conversely, excellent susceptibility rates were observed for amikacin (92.5%) and imipenem (95.3%). Extended-Spectrum Beta-Lactamase (ESBL) production was confirmed in 29.4% of the E. coli strains. Logistic regression showed that a history of empirical over-the-counter antibiotic use prior to hospital presentation was strongly associated with an ESBL-producing strain (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01). Bacterial pathogens causing secondary peritonitis exhibit high resistance to common cephalosporins, emphasizing the necessity of guiding postoperative therapeutic choices by fluid culture results rather than blind empirical protocols to avoid systemic septic complications.

Keywords: Acute Peritonitis, Escherichia coli, Antimicrobial Resistance, Ceftriaxone Resistance, Emergency Laparotomy, Peritoneal Fluid

Manuscript Timeline: Received: January 10, 2026; Revised: February 18, 2026; Accepted: March 12, 2026; Published: April 15, 2026.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Bacterial Pathogens and Antimicrobial Susceptibility Mapping among Adult Patients with Acute Suppurative Peritonitis. International Journal of Medicine and Medical Sciences, 2026, 16(4): 25–32. DOI: 10.46882/2026/IJMMS/160025

Subscribe to read the full article: https://internationalscholarsjournals.org/subscribe-to-read