Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer

Y. S. Shan, H. P. Hsu, Yu-Hsiang Hsieh, E. D. Sy, J. C. Lee, P. W. Lin

Research output: Contribution to journalArticle

Abstract

Background: The incidence of postoperative fungal infection is increasing and the gastrointestinal tract is the major source, but antifungal therapy in perforated peptic ulcer (PPU) is still controversial. The aim of this study was to determine the significance of intraoperative peritoneal fluid culture of fungus and establish the indications for treatment. Methods: Between July 1997 and September 2001, all patients admitted with a 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: One hundred and forty-five patients with a PPU were included; 63 (43.4 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.

Original languageEnglish (US)
Pages (from-to)1215-1219
Number of pages5
JournalBritish Journal of Surgery
Volume90
Issue number10
DOIs
StatePublished - Oct 2003
Externally publishedYes

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Ascitic Fluid
Peritonitis
Peptic Ulcer
Fungi
Surgical Wound Infection
Length of Stay
APACHE
Mortality
Mycoses
Incidence
Therapeutics
Hospital Mortality
Gastrointestinal Tract
Multivariate Analysis
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Surgery

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Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer. / Shan, Y. S.; Hsu, H. P.; Hsieh, Yu-Hsiang; Sy, E. D.; Lee, J. C.; Lin, P. W.

In: British Journal of Surgery, Vol. 90, No. 10, 10.2003, p. 1215-1219.

Research output: Contribution to journalArticle

Shan, Y. S. ; Hsu, H. P. ; Hsieh, Yu-Hsiang ; Sy, E. D. ; Lee, J. C. ; Lin, P. W. / Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer. In: British Journal of Surgery. 2003 ; Vol. 90, No. 10. pp. 1215-1219.
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AU - Lin, P. W.

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AB - Background: The incidence of postoperative fungal infection is increasing and the gastrointestinal tract is the major source, but antifungal therapy in perforated peptic ulcer (PPU) is still controversial. The aim of this study was to determine the significance of intraoperative peritoneal fluid culture of fungus and establish the indications for treatment. Methods: Between July 1997 and September 2001, all patients admitted with a 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: One hundred and forty-five patients with a PPU were included; 63 (43.4 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.

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