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Volume 50, Number 3, June 2017

Antifungal therapy did not improve outcomes including 30-day all-cause mortality in patients suffering community-acquired perforated peptic ulcer-associated peritonitis with Candida species isolated from their peritoneal fluid 


Wei-Sin Li, Chen-Hsiang Lee, Jien-Wei Liu


 

Corresponding author:

Jien-Wein Liu, Corresponding author. Division of Infection Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung District, Kaohsiung 833, Taiwan 



 

Background and purpose: 

Although patients suffering community-acquired perforated peptic ulcer (PPU)-associated peritonitis with Candida species isolated from their peritoneal fluid have higher chances of mortality and experiencing a complicated postoperative clinical course, universal antifungal therapy for these patients remains controversial. 



 

Methods:

This is a retrospective analysis of the impacts of antifungal therapy on outcomes of patients suffering community-acquired PPU-associated peritonitis with Candida species isolated from their ascites at a medical center in Taiwan. All included patients received source control and antibiotic treatment, with or without additional postoperative antifungal therapy with fluconazole or an echinocandin for at least 3 days. 



 

Results:

Among the 133 included patients, 76 did not receive (Group 1) and 57 did receive (Group 2) antifungal therapy. Sixteen (12%) of the overall included patients died within 30 days. Shock [odds ratio (OR), 5.6; 95% confidence interval (CI), 1.9–16.5; p = 0.002] and higher Acute Physiology and Chronic Health Evaluation II score (>20; OR, 9.5; 95% CI, 1.1–80.7; p = 0.04) were independently associated with 30-day mortality. Among the 80 matched patients from Groups 1 and 2 (1:1 matched) with the closest propensity score, no significant difference was found in 30-day all-cause mortality, time to mortality, the need for reoperation/abscess formation/anastomotic leakage, prolonged intensive care unit stay, and prolonged mechanical ventilator dependence between patients with and without antifungal therapy. 



 

Conclusion:

Our study provides solid evidence supporting the notions that antifungal therapies do not benefit patients suffering PPU peritonitis with Candida species isolated from their ascites in general, and antifungal therapy could be reserved for patients who are critically ill and/or severely immunocompromised. 



 

Key words:

antifungal therapy, Candida peritonitis, mortality