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Effect of Candida infection on outcome in patients with perforation peritonitis

Advait Prakash1, Dhananjaya Sharma, Arjun Saxena

  • 1Department of Surgery, NSCB Government Medical College, Regional Medical Research Centre for Tribals, Jabalpur, India.

Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology
|September 13, 2008
PubMed

Insights

Perforation peritonitis patients with positive cultures face higher mortality. Fungal infections significantly worsen prognosis, highlighting the need for early antifungal treatment in gastrointestinal perforation cases.

Area of Science:

  • Microbiology
  • Surgical Gastroenterology
  • Infectious Diseases

Background:

  • Perforation peritonitis, often caused by hollow viscus perforation, requires surgical and antibiotic intervention.
  • The role of specific microbial pathogens, particularly fungi, in peritonitis outcomes remains an area for investigation.

Purpose of the Study:

  • To identify bacterial and fungal microorganisms in patients with spontaneous gastrointestinal perforation peritonitis.
  • To assess the impact of these identified microorganisms on patient prognosis and mortality.

Main Methods:

  • Prospective study of 84 patients with spontaneous gastrointestinal perforation peritonitis undergoing surgery.
  • Analysis of peritoneal fluid via microbial culture and biochemical tests for bacteria and fungi.
  • Calculation of the Jabalpur Prognostic Score to evaluate patient outcomes.

Main Results:

  • Positive peritoneal fluid cultures were observed in 42 out of 84 patients.
  • Escherichia coli was the most frequent bacterium, and Candida the most common fungus.
  • Mortality was significantly higher in patients with positive cultures (15/42) versus negative cultures (0/42).
  • Mixed bacterial and fungal infections showed higher mortality (10/13) than isolated bacterial infections (5/29).
  • Positive fungal cultures correlated with higher-than-expected mortality when using the Jabalpur Prognostic Score.

Conclusions:

  • Gastrointestinal perforations with positive peritoneal cultures indicate a poor prognosis.
  • The presence of fungal cultures significantly worsens the prognosis.
  • Early detection and treatment of fungal infections are recommended for improved patient outcomes.

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