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.
Rahul Jain
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