Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations.
OBJECTIVE
Determine the significance of recovering yeasts from intraoperative specimens from the abdominal cavity and to evaluate the effect of a single intraoperative dose of fluconazole on clinical outcome in patients with intra-abdominal perforations.


METHODS
Prospective, randomized, double-blind study.


METHODS
Multicenter study from 13 hospitals in Norway.


METHODS
One hundred nine patients with intra-abdominal perforations.


METHODS
Patients were randomized to receive either a single 400-mg fluconazole dose or placebo during the operation.


RESULTS
An intra-abdominal specimen for microbiological culture was obtained at the time of the operation. The primary response variable in the study was death. Secondary response variables were three parameters indicating a complicated postoperative period: mechanical ventilation for > or = 5 days, intensive care treatment for > or = 10 days, and use of a central venous catheter for > or = 10 days. Yeasts were recovered from a intraoperative intra-abdominal specimen from only 1 (3.5%) of 28 patients with perforated appendicitis and from 32 (39.5%) of 81 nonappendicitis patients. Excluding the appendicitis patients, the yeast recovery rate was high both for patients hospitalized at the time of the perforation (45%) and for nonhospitalized patients (32%). The overall mortality was 11% (12 patients). Single-dose intraoperative fluconazole prophylaxis did not reach a statistically significant effect on mortality (4 of 53 patients in the fluconazole group and 8 of 56 patients in the placebo group died [p = .059]). The only two explanatory variables significantly related to death were a intraoperative finding of yeast from an intra-abdominal specimen and the occurrence of a spontaneous perforation in a patient already hospitalized for nonsurgical cancer treatment. Detection of yeast was also a significant explanatory variable for a prolonged period of mechanical ventilation, intensive care treatment, and prolonged use of a central venous catheter.


CONCLUSIONS
Single-dose intraoperative fluconazole prophylaxis did not have a statistically significant effect on overall mortality (odds ratio = 0.21; 95% confidence interval, 0.04-1.06; p = .059) in patients with intra-abdominal perforation. The recovery rate of yeast from intraoperative specimens from the abdominal cavity was high (>30%) and was associated with death and a complicated postoperative course.
Sandven
Per
P
Department of Bacteriology, Norwegian Institute of Public Health, Oslo. per.sandven@folkehelsa.no
Qvist
Hanne
H
Skovlund
Eva
E
Giercksky
Karl E
KE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology; D004311:Double-Blind Method; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007416:Intestinal Perforation / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011379:Prognosis; D012306:Risk; D012421:Rupture; D013272:Stomach Diseases / Q000382:microbiology* / Q000401:mortality / Q000601:surgery
D000935:Antifungal Agents; D015725:Fluconazole