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Candida and perforated peptic ulcers.

J B Peoples

    Surgery
    |October 1, 1986
    PubMed
    Summary

    Candida in peritoneal fluid during perforated peptic ulcer surgery does not necessitate antifungal treatment. Its presence, especially with bacteria, is linked to older age and shock, not Candida

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    Area of Science:

    • Gastroenterology
    • Infectious Diseases
    • Surgical Critical Care

    Background:

    • Perforated peptic ulcers with Candida in peritoneal cultures have historically indicated poor prognosis.
    • This association led to consideration of systemic antifungal agents for affected patients.
    • Concerns regarding antifungal toxicity and cost prompted a review of this association.

    Purpose of the Study:

    • To investigate the association between Candida isolation from peritoneal cultures and patient outcomes in perforated peptic ulcer disease.
    • To determine if Candida in peritoneal fluid independently predicts mortality or requires specific antifungal therapy.

    Main Methods:

    • Retrospective review of 48 patients operated on for benign perforated ulcers between 1980 and 1985.
    • Intraoperative peritoneal cultures were analyzed for microbial growth.
    • Patient demographics, culture results, and mortality rates were correlated.

    Main Results:

    • Candida was isolated in 57% of positive cultures (16/28 patients).
    • Overall mortality was 16.7%; 25% for patients ≥65 years.
    • Mortality for patients with Candida was 18.8%, but 0% for Candida alone and 50% for mixed Candida-bacterial cultures. No antifungal therapy was administered, and no candidiasis developed.

    Conclusions:

    • The association of peritoneal Candida with increased mortality in perforated peptic ulcers is likely confounded by advanced age and shock.
    • Candida in this context appears non-pathogenic and does not warrant systemic antifungal therapy.
    • Management should focus on addressing age, shock, and bacterial co-infections rather than Candida.

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