Candida isolation from peritoneal fluid: Its role in the outcome of patients with perforation peritonitis

Abstract

Objective: Perforation peritonitis is a common surgical emergency which is treated by surgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment is not a norm. The aim of this study was to determine the incidence of Candida in peritoneal fluid and its role in the outcome of patients with perforation peritonitis. Methods: This prospective observational study was conducted on 70 patients with perforation peritonitis from October 2016 to February 2018. Intraoperatively, peritoneal fluid was taken and sent for microbiological culture and sensitivity. Perforation was managed according to the site of perforation and condition of bowel. Results: The mean age of the patients was 38.74 years with male predominance (58, 82.85%). Forty-seven (67.14%) patients had positive peritoneal cultures. Escherichia coli was the most common bacteria (n=29), while Candida was found to be the most common fungi and was found in 18 patients. The incidence of Candida was higher in upper gastro-duodenal perforation (30, 42.85%). Patients found positive for Candida had APACHE II severity score 10 or more which was higher than the rest of the patients. The mortality was higher in patients with positive peritoneal cultures (10/47) as compare to negative ones (2/23, P<0.001). The mortality in mixed bacterial and fungal-positive cultures (7/18) was also higher as compared to isolated bacterial culture (3/29, P<0.001). The overall mortality rate was 17.14%. Conclusion: Patients with Candida positive peritoneal culture had a significant mortality and morbidity as compared to Candida negative. Peritoneal fluid culture and sensitivity for bacterial and fungal were helpful in the early diagnosis and treatment.