<abstract xmlns="http://www.w3.org/1999/xhtml">The gastrointestinal tract perforation is one of the leading causes of acute abdomen. Mycotic infections have become a significant clinical problem over the last few decades. Despite the advance in diagnostics and treatment of patients with fungal peritonitis, the mortality remains high.<bold>Objective.</bold> The objective of the study was to determine the type and incidence of causative pathogens of acute peritonitis in patients with gastroduodenal perforation, and to estimate the impact of microbial flora on the disease outcome.<bold>Materials and methods.</bold> We performed a retrospective study among 83 adult patients with acute peritonitis due to gastroduodenal perforation treated at our centre.<bold>Results.</bold> A total of 40 mycotic agents were isolated in 39 of the abdominal samples. The primary mycotic isolates were Candida albicans (52.5%) and C. glabrata (64.3%); C. krusei (14.3%) and C. tropicalis (7.1%) predominated among non-albicans Candida species (35.0%). The most common bacterial agents were Escherichia coli (24.0%) and Enterococcus spp. (24.0%). 77.1% of all enrolled patients survived, and 19 of them deceased due to sepsis and multiple organ dysfunction syndrome.<bold>Conclusion.</bold> Candida albicans is the most common mycotic pathogen in patients with acute peritonitis due to gastroduodenal perforation. It is obligatory to examine the peritoneal fluid samples for bacterial and fungal pathogens with determination of their antimicrobial susceptibility profile. Timely initiation of adequate treatment and multidisciplinary approach is crucial for the outcome of patients with fungal peritonitis.</abstract>

The gastrointestinal tract perforation is one of the leading causes of acute abdomen. Mycotic infections have become a significant clinical problem over the last few decades. Despite the advance in diagnostics and treatment of patients with fungal peritonitis, the mortality remains high.Objective. The objective of the study was to determine the type and incidence of causative pathogens of acute peritonitis in patients with gastroduodenal perforation, and to estimate the impact of microbial flora on the disease outcome.Materials and methods. We performed a retrospective study among 83 adult patients with acute peritonitis due to gastroduodenal perforation treated at our centre.Results. A total of 40 mycotic agents were isolated in 39 of the abdominal samples. The primary mycotic isolates were Candida albicans (52.5%) and C. glabrata (64.3%); C. krusei (14.3%) and C. tropicalis (7.1%) predominated among non-albicans Candida species (35.0%). The most common bacterial agents were Escherichia coli (24.0%) and Enterococcus spp. (24.0%). 77.1% of all enrolled patients survived, and 19 of them deceased due to sepsis and multiple organ dysfunction syndrome.Conclusion. Candida albicans is the most common mycotic pathogen in patients with acute peritonitis due to gastroduodenal perforation. It is obligatory to examine the peritoneal fluid samples for bacterial and fungal pathogens with determination of their antimicrobial susceptibility profile. Timely initiation of adequate treatment and multidisciplinary approach is crucial for the outcome of patients with fungal peritonitis.

Fungal Peritonitis Due to Gastroduodenal Perforation: Diagnostic and Treatment Challenges

University Hospital “Alexandrovska”, Medical University – Sofia

Acta Medica Bulgarica

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

The gastrointestinal tract perforation is one of the leading causes of acute abdomen. Mycotic infections have become a significant clinical problem over the...

Fungal Peritonitis Due to Gastroduodenal Perforation: Diagnostic and Treatment Challenges

Published Online: May 21, 2020

Page range: 24 - 31

Received: May 01, 2019

Accepted: Jun 01, 2019

DOI: https://doi.org/10.2478/amb-2020-0004

Keywords
acute peritonitis, gastroduodenal perforation, mycotic infection, critically ill, treatment

© 2018 D. Tzoneva et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fungal Peritonitis Due to Gastroduodenal Perforation: Diagnostic and Treatment Challenges

Published Online: May 21, 2020

Page range: 24 - 31

Received: May 01, 2019

Accepted: Jun 01, 2019

DOI: https://doi.org/10.2478/amb-2020-0004

Keywordsacute peritonitis, gastroduodenal perforation, mycotic infection, critically ill, treatment

© 2018 D. Tzoneva et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
acute peritonitis, gastroduodenal perforation, mycotic infection, critically ill, treatment