Abstract
One hundred twenty-three pediatric cases with panperitonitis were treated at the Pediatric Surgical Department, Chiba University Hospital during the period of January 1973 through December 1979. The organisms, which were isolated at the operation, were E.Coli 67%, Bacteroides fragilis 49%, Klebsiella 32%, Enterococcus 15%, Pseudomonas aeruginosa 14%. Aerobic organisms were isolated in the cases with perforation of the upper gastrointestinal tract, on the other hand, aerobic gram negative rodds and anaerobic Bact. fragilis were isolated in those with lower intestinal tract perforation. The isolation rate of Anaerobic organisms in perforation of the alimentary tract was 12% in stomach, 12.5% in duodenum, 12.5% in jejunum, 28% in ileum, 82% in appendix, and 58% in colon. The isolated organisms from blood cultures were all aerobic gram negative rodds and all but one child of this group died. Aerobic gram negative rodds and anaerobic Bact. fragilis were isolated from the postoperativd infectious lesions. Bact. fragilis was isolated in 8 among 10 cases of the intra-abdominal abscess. Aerobic gram negative rodds, especially Pseudomonas aeruginosa, had resistance against Penicillin & Cephalosporin, but susceptible to Aminoglycoside (Gentamicin, Tobramycin, etc.). Aerobic gram positive Enterococcus was completely susceptible to ABPC. Anaerobic Bact. fragilis was resistant to Aminoglycoside, PC and Cephlospolin, but was susceptible to Chloramphenicol, Lincomycin and Clindamycin. The result of this study leads a conclusoon that the combination of ABPC & Aminoglycoside is the most effective chemotherapy in cases of perforation of the upper gastrointestinal tract, and the combination of Aminoglycoside & Lincomycin in those of the lower intestinal tract.
