MycologyCandida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B
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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Primary closure versus Graham patch omentopexy in perforated peptic ulcer: A systematic review and meta-analysis
2022, SurgeonCitation Excerpt :The prevalence is decreasing due to the use of proton pump inhibitors (PPIs) and the treatment of helicobacter pylori. The management is almost always operative in addition to fluid resuscitation, empirical antibiotics, antifungals and acid suppression.1,2 Recent data from National Emergency Laparotomy Audit (NELA), reported postoperative mortality of up to 18% in England and Wales.3
Antifungal therapy did not improve outcomes including 30-day all-cause mortality in patients suffering community-acquired perforated peptic ulcer-associated peritonitis with Candida species isolated from their peritoneal fluid
2017, Journal of Microbiology, Immunology and InfectionCitation Excerpt :Limitations of this study include (1) nonrandomized patient allocation and inevitable missing data, which are always inherent in a retrospective study, and (2) the lack of identification of all the species of Candida isolated from the intraperitoneal fluid, which was done only at our hospital under the request of the clinician. Nonetheless, most of the Candida isolates that grew from the intraperitoneal fluid of patients suffering PPU peritonitis are Candida albicans.2–7,26,27 All C. albicans isolates at KCGMH have been found to be susceptible to fluconazole and echinocandins (data not shown).
Guidelines for management of intra-abdominal infections
2015, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :(Grade 1–) STRONG agreement Rationale: The data of the literature show that it is unnecessary to institute empirical antifungal therapy for community-acquired peritonitis in the absence of signs of severity, except in immunodepressed patients, transplant recipients or patients with an inflammatory disease [34–36]. R15 – Antifungal therapy should probably be initiated in severe peritonitis (community-acquired or postoperative), in the presence of at least 3 of the following criteria: haemodynamic failure, female gender, upper gastrointestinal surgery, antibiotic therapy for more than 48 hours.