Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer.
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.


CONCLUSIONS
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.
D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D010439:Peptic Ulcer Perforation / Q000382:microbiology*; D010538:Peritonitis / Q000382:microbiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents