Abstract
IntroductionFungal infection of the peritoneum has become more common in recent years, the most common cause of which is Candida. Candida peritonitis is considered as a severe disease and is regarded as an independent risk factor for mortality in postoperative peritonitis. This study was planned to find out the clinical significance of Candida isolation on the outcome of the patients with peritonitis in terms of morbidity and mortality.MethodsThis prospective study included consecutive patients admitted and operated for secondary peritonitis over a two-year period in a tertiary care hospital in South India. The time delay was assessed from the onset of symptoms to surgery. The intraoperative peritoneal fluid aspirate was analyzed for culture sensitivity (fungal and bacterial). Patients were followed until their discharge from the hospital or death. This study analyzed the clinico-microbiological profile in patients with perforation peritonitis with special reference to Candida isolation. The analysis also looked the results of antifungal therapy (fluconazole) in patients positive for Candida isolation.ResultsThe study included 407 consecutive patients with hollow viscus perforation diagnosed intraoperatively. Fungal organisms were identified in 153 patients (37.6%). Old age (> 50 years), high lag period (≥ 48 hours), peritoneal contamination, length of hospital stay, the presence of co-morbidities, shock at presentation, and postoperative complications were found to be significantly associated with fungal infection (p < 0.05). The study noted a significant decrease in the perioperative complications in patients who were started on antifungal treatment early (within 72 hours after surgery). There were significant reductions in the length of hospital stay, intensive care unit (ICU) stay, ventilator support, and inotropic support in the postoperative period. However, we did not find any difference in mortality due to early treatment with fluconazole.ConclusionCandida peritonitis was associated with an increase in the mortality and morbidity, especially when associated with diabetes mellitus and fungemia. Early antifungal therapy (within 72 hours after surgery) reduced the morbidity due to Candida peritonitis but did not affect the mortality.
Highlights
Fungal infection of the peritoneum has become more common in recent years, the most common cause of which is Candida
Candida peritonitis is considered as a severe disease and is regarded as an independent risk factor for mortality in postoperative peritonitis
Old age (> 50 years), high lag period (≥ 48 hours), peritoneal contamination, length of hospital stay, the presence of co-morbidities, shock at presentation, and postoperative complications were found to be significantly associated with fungal infection (p < 0.05)
Summary
This prospective study included consecutive patients admitted and operated for secondary peritonitis over a two-year period in a tertiary care hospital in South India. The analysis looked the results of antifungal therapy (fluconazole) in patients positive for Candida isolation This prospective clinical study was conducted for two years in a tertiary care hospital, in South India. The poor general condition of a few patients was the reason for a delay in surgery These patients underwent bilateral preoperative flank drain placement (n = 16), and the fluid was sent for fungal culture and sensitivity. Such patients who succumbed to the disease (n = 16) were excluded from analysis. The intraoperative findings, which were recorded, included the size of the perforation, the amount and the nature of the contamination, and the intraoperative hemodynamic stability
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