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Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective

Introduction 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. This study was planned to...

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Autores principales: Pramod, Jagannath, Vijayakumar, Chellappa, Srinivasan, Krishnamachari, Maroju, Nanda Kishore, Raj Kumar, Nagarajan, Balasubramaniyan, Gopal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935435/
https://www.ncbi.nlm.nih.gov/pubmed/29736359
http://dx.doi.org/10.7759/cureus.2275
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author Pramod, Jagannath
Vijayakumar, Chellappa
Srinivasan, Krishnamachari
Maroju, Nanda Kishore
Raj Kumar, Nagarajan
Balasubramaniyan, Gopal
author_facet Pramod, Jagannath
Vijayakumar, Chellappa
Srinivasan, Krishnamachari
Maroju, Nanda Kishore
Raj Kumar, Nagarajan
Balasubramaniyan, Gopal
author_sort Pramod, Jagannath
collection PubMed
description Introduction 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. 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. Methods 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 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. Results The 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. Conclusion Candida 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.
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spelling pubmed-59354352018-05-07 Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective Pramod, Jagannath Vijayakumar, Chellappa Srinivasan, Krishnamachari Maroju, Nanda Kishore Raj Kumar, Nagarajan Balasubramaniyan, Gopal Cureus Gastroenterology Introduction 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. 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. Methods 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 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. Results The 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. Conclusion Candida 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. Cureus 2018-03-05 /pmc/articles/PMC5935435/ /pubmed/29736359 http://dx.doi.org/10.7759/cureus.2275 Text en Copyright © 2018, Pramod et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Gastroenterology
Pramod, Jagannath
Vijayakumar, Chellappa
Srinivasan, Krishnamachari
Maroju, Nanda Kishore
Raj Kumar, Nagarajan
Balasubramaniyan, Gopal
Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective
title Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective
title_full Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective
title_fullStr Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective
title_full_unstemmed Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective
title_short Clinical Significance of Candida in an Intraoperative Peritoneal Specimen with Perforation Peritonitis: An Institutional Perspective
title_sort clinical significance of candida in an intraoperative peritoneal specimen with perforation peritonitis: an institutional perspective
topic Gastroenterology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935435/
https://www.ncbi.nlm.nih.gov/pubmed/29736359
http://dx.doi.org/10.7759/cureus.2275
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