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KMID : 0378019880310010042
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New Medical Journal
1988 Volume.31 No. 1 p.42 ~ p.48
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Clinical Significance of Candida in Peptic Ulcer Perforation
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Abstract
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Peritoneal spillage often appears alarmingly extensive in patients with perforated peptic ulcers. In an.effort to control infection, intraoperative peritoneal cultures are obtained. Candida species are often is uncertain we there fore analyzed clinical significance of positive candida culture in patients with perforated peptic ulcer in order to provide guideline for anti-fungal therapy.
During September 1984 to June 1987, 106 patients were operated on for benign perforated ulce°. Intraoperative cultures were obtained in 60 patients.
The results obtained as follows:
1. The mean age of the patient was 37 years with a range of 17 to 69 years.
2. Fifty-seven patients(95%) were men and three patients(5%) were women.
3. Fifty-six ulcers(93%) were classified as duodenal (including pyloric channel and prepyloric) an. four
(7%) were classified as gastric.
4. The operation performed truncal vagotomy and pyloroplasty in 27 patients(45%), subtotal gastrecI-omy in 20 patients(33%), Graham procedure in 11 patients(19%), and truncal vagotomy and antrec:omy in 2 patients(3%).
5. Of 60 patients with intraoperative peritoneal culture, twenty-two(3707o) had microorganisms: Fifteen(68%) produced bacteria only and seven(32%) grew Candida either alone(5 patients) or in combination with bacteria (2 patients).
6. Six patients(10%) were clinically in shock(systolic blood pressure <100 mmHg, pulse rate >100/min)
at the time of diagnosis. Of these 6, five(83%) had microorganisms; four(80%) grew bacteria only,
one(20%) grew Candida only, and no patients in shock grew Candida in combination with bacteria. 7. Fifty-four patients(90%) were clinically not in shock at the time of diagnosis. Of these 54, seventeen 31%)
had microorganisms; Eleven(65%) grew bacteria only, four(23%) grew Candida only, and Two(12%)
grew Candida in combination with bacteria.
8. Nineteen complications developed postoperatively; pleural effusion in 5, wound infection in 4, =sepsis
in 3, pneumonia in 3, intraabdominal abscess in 2, and adhesion in 2.
9. The overall mortality rate was 3.3%(2/60). The mortality rate for patinets with positive intraoperative
culture was 9.1%(2/22). In 7 patients with positive Candida culture, no patients was treated with systemic antifungal agents, no patients developed fungemia or disseminated candidiasis, and no patie-it died.
As a result, I think that a positive intraoperative culture with Candida in perforated peptic ulcers does not require systemic antifungal therapy.
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