Candida Peritonitis: An Update on the Latest Research and Treatments

Abstract

AbstractThe incidence of Candida peritonitis is increasing and the mortality rate remains high. Candida albicans is the most common yeast causing Candida peritonitis, but a shift to more drug‐resistant non‐albicans strains has been observed. Major risk factors for developing Candida peritonitis include hollow viscus perforation, abdominal and thoracic surgery, surgical drains in situ, intravenous and urinary catheters, total parenteral nutrition, severe sepsis, antibiotic therapy (≥48 h before peritonitis), immunosuppression, diabetes mellitus, and extensive Candida colonization. Polymicrobial peritoneal infections with Candida spp. and enteric bacteria (such as E. coli and B. fragilis) have been associated with higher mortality. Laboratory detection of Candida is still based on histopathological diagnosis and culture‐based methods. Isolated Candida spp. must be treated as a pathogen contributing to peritonitis. Prompt diagnosis, effective antifungal therapy, and skilled surgical management are essential components of treatment. Treatment includes removal of all foreign bodies, such as intravenous and urinary catheters and drains, whereas abscesses usually require surgical or radiological drainage. Antifungal therapy should be chosen based on sensitivity profiles. Fluconazole is still appropriate for most severe community‐acquired or nosocomial infections. Echinocandins are used as first‐line in critically ill patients, those with prior azole exposure, and those with fluconazole‐resistant candidiasis. Peritoneal lavage can be used in combination with other antifungal agents to treat refractory infections. Risk factors must be weighed to decide on prophylaxis (usually with fluconazole) to limit antifungal resistance.