Candida and perforated peptic ulcers

Patients with perforated peptic ulcers who have Candida isolated from peritoneal culture have been noted to have a poor prognosis. Therefore treatment of such patients with systemic antifungal agents has been considered. Because of the toxicity and expense of such therapy, a review of the association was performed. During 1980 to 1985, 48 patients were operated on for benign perforated ulcer. The mean age of the patient group was 66 years. Intraoperative cultures were obtained in 38 patients. Microorganisms were isolated in 28 (74%) patients. Candida was isolated in 16 (57%) of the positive cultures. The overall mortality rate was 16.7%. The mortality rate for patients 65 years of age or older was 25% compared with 0% for those younger than 65 years old. The mortality rate for patients with Candida in their peritoneal fluid was 18.8%. No patient was treated with systemic antifungal agents. No patient developed candidiasis. Of the 16 patients in whom Candida was isolated, it was the only organism in 10 patients and was found in mixed culture with bacteria in six. The mortality rate for patients with Candida alone was 0%. The mortality rate for patients with mixed cultures was 50%. The presence of mixed cultures correlated strongly with both advanced patient age and shock. These factors have previously been correlated with death. It is concluded that the association between peritoneal Candida and excessive death from perforation is linked by an intervening association to advanced age and shock. In this setting, Candida does not appear to be normally pathogenic and does not require systemic antifungal therapy.