Fungal Culture Positivity in Patients with Perforation Peritonitis

Perforation peritonitis is the most common surgical emergency. A large number of microorganisms have been cultured from the abdominal fluid obtained from patients with gastrointestinal perforation peritonitis. The present study was undertaken to determine the frequency of positive fungal culture in perforation peritonitis as Candida co-infection is reported to be a bad prognostic factor in these patients.

The intraoperative specimens of abdominal fluid collected during laparotomy from 140 consecutive patients of gastro-intestinal perforation were analysed by microbial culture for bacteria and fungi. Their antimicrobial susceptibility was also studied.

The mean presenting age of the patients was 35 years and 120 (85.7%) of them were males. Aerobic Gram Negative Bacilli (AGNB) were observed in 82 (79.6%) of the culture positive abdominal fluid specimens, of which 58 (70.7%) were Escherichia coli. Gram negative bacteria were most frequently isolated from colorectal perforation (100%) while Gram positive bacteria were from upper gastrointestinal perforation (47.2%). Candida was cultured in as many as 68 of 140 (48.6%) specimens. Its prevalence was highest in patients with gastroduodenal perforation (70.5%) and was altogether absent in patients having appendicular perforation.

High prevalence of fungal culture positivity of peritoneal fluid of patients of perforation peritonitis shows that along with the bacterial culture, fungal cultures should always be asked for in such patients. Adequate and timely antimicrobial treatment including treatment of fungal infection could help reduce mortality in this group of patients.