When are intraoperative peritoneal fluid cultures indicated?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

Routine intraoperative peritoneal fluid cultures in defined acute disease entities (ie, gastric or duodenal ulcer perforation, appendicitis, diverticulitis or perforation of the colon caused by obstruction or ischemia) are controversial. Several studies found no significant difference in patients with appendicitis, diverticulitis, and other common etiologies for bacterial peritonitis with regard to postoperative complication rates or overall outcomes. The antibiotic regimen was altered only 8-10% of the time based on operative culture data. In patients who had previous abdominal operations or instrumentation (eg, peritoneal dialysis catheter, percutaneous stents) and patients with prolonged antibiotic therapy, critical illness, and/or hospitalization, these cultures may reveal resistant or unusual organisms that should prompt alteration of the antibiotic strategy.

For a summary of ascitic fluid analysis, see Table 4, below.

Table 4. Ascitic Fluid Analysis Summary [5] (Open Table in a new window)

Routine

Optional

Unusual

Less Helpful

Cell count

Obtain culture in blood culture (BC) bottles.

Tuberculosis (TB) smear and culture

pH

Albumin

Glucose

Cytology

Lactate

Total protein

Lactate dehydrogenase (LDH)

Triglyceride

Cholesterol

 

Amylase

Bilirubin

Fibronectin

 

Gram stain

 

Alpha 1-antitrypsin

 

 

 

Glycosaminoglycans


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