Mycology
Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B

Part of the content of this manuscript has been presented as poster in the 41st Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC) of American Society of Microbiology in Chicago in December 16–19, 2001.
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Abstract

Sixty-two cases of peritonitis due to peptic ulcer perforation were diagnosed between January 2000 and December 2000. Of these 62 cases, 23 isolates of Candida in 23 cases (CP) were cultured from peritoneal fluid. Cultures of peritoneal fluid of 10 (BP) of the remaining 39 cases was positive for bacteria only. Cultures of peritoneal fluid of the remaining 29 cases was negative. Comparison of CP, BP and culture-negative cases did not reveal any significant risk factor. Of the 23 Candida isolates, the Candida species and 48-h MICs of fluconazole and amphotericin B (mean, range ug/ml) were C. albicans 18 (0.688, 0.125–1.0; 0.297, 0.031–0.5), C. glabrata 3 (0.542, 0.125–1.0; 0.25, 0.125–0.5), C. tropicalis 1 (0.25; 0.5), C. intermedia 1 (1.0; 0.125) respectively. Mortality rates of CP, BP and culture-negative peritonitis due to infection were 5/23(21.7%), 0/10 and 1/29(3.4%) respectively. Without effective antifungal therapy, the mortality rate of CP was not low.

Introduction

Although peritonitis due to Candida after intestinal perforation has been reported Bayer et al 1976, Calandra et al 1989, Lee et al 2000, the incidence and risk factors of Candida peritonitis due to peptic ulcer perforation have not been specifically investigated and reported. Although antifungal therapy for Candida peritonitis is indicated according to prior reports, the susceptibility of Candida isolates to fluconazole and amphotericin B in Candida peritonitis (CP) due to peptic ulcer perforation (PUP) has not been reported (Calandra et al., 1989). The purpose of this study is to find out the incidence rate, risk factors and prognosis of Candida peritonitis in cases of peptic ulcer perforation and the susceptibility of Candida isolates to fluconazole and amphotericin B according to the macrodilution antifungal susceptibility test M27-A approved by the National Committee for Clinical Laboratory Standards (NCCLS).

Section snippets

Patient enrollment

All cases of peritonitis due to peptic ulcer perforation in Chang Gung Memorial Hospital at Keelung between January 1, 2000 and December 30, 2000 that met the following criteria were included in this study: 1. Peritonitis due to PUP confirmed during operation. 2. Bacterial and fungal culture of peritoneal fluid performed during operation. Patient charts were reviewed to collect pertinent data including age, sex, duration between perforation and operation, underlying diseases, prior admission,

Results

Of the 62 peritonitis cases, culture of the peritoneal fluid grew Candida alone or mixed with bacteria in 23 cases (CP), only bacteria in 10 cases (BP) and were negative in 29 cases (Table 1). The incidence of CP in peritonitis due to PUP was thus 23/62 (37.1%). There was no significant difference in mean age and sex ratio between CP and BP patients. But there was a significantly higher proportion of male among culture-negative peritonitis (CNP) patients (Table 1). The mean duration between

Discussion

Candida peritonitis due to chronic ambulatory peritoneal dialysis, intestinal perforation and after intraabdominal operation has been reported in the literature (Amici et al 1994, Bint et al 1987; Dean et al., 1998; Eubanks et al 1993, Johnson et al 1985; Sobel et al., 1988). Eggimann performed a randomized, double-blind study of prophylaxis of intra-abdominal candidiasis in patients with recurrent gastrointestinal perforation or anastomotic leakage in 1999 and found that seven of twenty

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