Title: Incidence and Significance of Intra-Operative Peritoneal Fluid Fungal Culture in Patients of Perforated Peptic Ulcers
Authors: Amit Katlana, Atul Kumar Vyas, Rahul Jain, Abhinav Rathi, Navin Kumar Sharma, Anil Kumar Yadav, Kaushlendra Singh Narwariya
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.110
Abstract
Background: Perforation peritonitis is the most common surgical crisis in India. It is polymicrobial in nature. Till recently the emphasis has been given on identification of microbial flora associated with perforation peritonitis. The aim of this study was to determine the significance of intraoperative peritoneal fluid culture of fungus and to establish the indications for treatment.
Methods: Fifty three patients admitted with a Perforated peptic ulcer (PPU) were studied. Clinical data and peritoneal fluid for culture were collected. Risk factors for a positive peritoneal fluid culture of fungus and outcome were evaluated and related to the development of surgical site infection, duration of hospital stay and mortality rate.
Results: 53 with a PPU were included; 24 (45.2 per cent) had positive peritoneal fluid fungal culture. Age, preoperative organ failure, delay in operation, high Mannheim Peritonitis Index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and preoperative antibiotic therapy were risk factors for a positive fungal culture. Sex and an MPI score of 20 or more remained significant in multivariate analysis (P< 0·001). Patients with a positive fungal culture had a higher incidence of surgical site infection, a longer hospital stay and a significantly higher mortality rate, especially when this was combined with a high MPI score.
Conclusion: Positive peritoneal fungal culture was common and was a significant risk factor for adverse outcome in patients with a PPU. A high MPI score could be used as an indicator for prophylactic antifungal therapy.
Keywords: Perforation peritonitis ,peritoneal fungal culture, indications for treatment.
References
1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13 :818–29.
2. Mishra A, Sharma D, Raina VK. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol 2003;22 : 49–53
3. Sandven P, Qvist H, Skovlund E, Giercksky KE; NORGAS Group and the Norwegian Yeast Study Group. Signific-ance of Candida recovered from intraope-rative specimens in patients with intra-abdominal perforations.Crit Care Med 2002;30:541– 7.
4. Lee SC, Fung CP, Chen HY, Jwo SC, Hung YB, See LC, et al. Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B. DiagnMicrobiol Infect Dis 2002;44:23–7.
5. Shan YS, Hsu HP, Hsieh YH, Sy ED, Lee JC, Lin PW. Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer.Br J Surg 2003;90:1215–9.
6. Konnes, RJ, Cutitar, M, Burchard, KW. Perforated peptic ulcer, determinants of morbidity and mortality. Am Surg. 1990;56:280–284.
7. Ghoshal UC(1), Kochhar R, Goenka MK, Chakravorty A, Talwar P, Mehta SK. Fungal colonization of untreated peptic ulcer Ind journal of Gasroenterologyy 1994 Oct;13(4):115-7.
8. Zwolińska-Wcisło M(1), Budak A, Trojanowska D, Bogdał J, Stachura J Fungal colonization of the stomach and its clinical relevance Mycoses 1998 Sep-Oct;41(7-8):327-34.
9. Wright WL, Wenzel RP. Nosocomial Candida. Epidemiology, transmission, and prevention. Infect Dis Clin North Am 1997;11:411–425
10. D’Amelio, L. F., B. Wagner, S. Azimuddin, J. P. Sutyak, and J. S. Hammond. 1995. Antibiotic patterns associated with fungal colonization in critically ill surgical patients. Am. Surg. 61: 1049–1053.
11. Solomkin JS, Flohr JS, Quie JS, Simmons JS, .The role of Candida in intraperitoneal infections. Surger Surgery. 1980 Oct;88 (4): 524–530.