Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer

Shan, Yan–Shen; Hsu, Hsiang‐Chin; Hsieh, Yu Hsiang; Sy, Edgar D.; Lee, J. C.; Lin, Pin–Wen

doi:10.1002/bjs.4267

Cited by 40 publications

(53 citation statements)

References 21 publications

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“…Peritonitis in both animals and humans frequently is polymicrobial, and the organisms include E. coli and Bacteroides species (16,38). Antibiotic therapy has been proven to be effective for management of clinical intra-abdominal infections (1,23) and improves survival in the CLP model of sepsis (28,41,42).…”

Section: Discussionmentioning

confidence: 99%

“…These infections generate a peritoneal inflammatory response to polymicrobial organisms derived from the gastrointestinal tract (16,38). Clinical peritonitis may originate from a defect in an abdominal viscus, such as an acute intestinal perforation (49), that progresses to sepsis, resulting in high morbidity and mortality in both experimental animals (28,48) and patients (2,24).…”

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confidence: 99%

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Mechanisms of Mortality in Early and Late Sepsis

2006

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A recent hypothesis postulates that sepsis moves through different phases, with periods of enhanced inflammation alternating with periods of immune suppression. In this study we determined the levels of inflammation present during early and late septic deaths to examine whether death was due to hyperinflammation or immunosuppression. The murine model of sepsis induced by cecal ligation and puncture (CLP) was used. Complete blood counts, plasma interleukin-6 (IL-6) levels, and body weights were determined. Mice that died within the first 4 days had increased plasma levels of IL-6, indicating that there was activation of the immune system. Cecal resection on day 4 after CLP resulted in decreased abscess size, lower circulating neutrophil counts, decreased anemia, and improved survival compared to the results for mice that received only antibiotic and fluid therapy. All of the mice that died in the chronic phase of infection (after day 4) had positive peritoneal cultures containing significantly more bacteria than the cultures for surviving mice. After day 4, none of the surviving mice exhibited increases in the plasma levels of IL-6. Dying mice exhibited mixed IL-6 responses; for 41% of the mice there was never an increase in the IL-6 levels in the chronic phase, while for other mice the levels of IL-6 transiently increased prior to death. Peritoneal macrophages were obtained in the late phase of sepsis from moribund and healthy mice and were stimulated ex vivo. The cells from the moribund mice produced significantly less IL-6 than the cells obtained from healthy mice produced. These results indicate that in mice that die in the early phase there is uniformly increased inflammation. However, during the chronic phase of sepsis, some mice die with evidence of immunosuppression (increased bacterial growth and low IL-6 levels), while other mice die with immunostimulation (high IL-6 levels and bacterial growth). Determining the inflammatory status of individual patients may help guide appropriate, targeted therapy.Sepsis remains a significant clinical problem (34) despite recent advances in early goal-directed therapy (35), the use of activated protein C (6), and the use of low-dose glucocorticoids (3). A recent review of discharge records showed that there were an estimated 751,000 cases per year with an overall mortality rate of 29% (2). While in-hospital mortality has declined, the total number of deaths continues to rise due to the increased incidence of sepsis (24). There remains a critical, unmet need to better understand the basic immunopathologic alterations present in individual septic patients in order to appropriately guide therapy.Intra-abdominal infections may be a source for sepsis. These infections generate a peritoneal inflammatory response to polymicrobial organisms derived from the gastrointestinal tract (16,38). Clinical peritonitis may originate from a defect in an abdominal viscus, such as an acute intestinal perforation (49), that progresses to sepsis, resulting in high morbidity and mortality in ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mechanisms of Mortality in Early and Late Sepsis

2006

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“…As in the study by Y.S. Shan and J.C. Lee (1997Lee ( -2001) (5) and by Elliot and Frank and Alden 1984-87 age >60 years is an independent risk factors for fungal peritonitis and is significantly related to a positive intraperitoneal fungal culture. Risk factors were also evaluated for the disease progress and outcome.…”

Section: Discussionmentioning

confidence: 71%

“…Factors foretelling outcome in cases of perforation peritonitis are well known and have been well acknowledged in the construction of various scoring systems. (1,2) Increasing awareness of worse outcome after fungalco-infection, (3,4,5) and the knowledge that intra-abdominal microbialogical findings do not correlate with severity of illness as judged by the scoring systems, impelled usto conduct this study.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Significance of Intra-Operative Peritoneal Fluid Fungal Culture in Patients of Perforated Peptic Ulcers

Katlana¹

2017

jmscr

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“…But the URT in isolated sites (peritoneal or intragastric) was not equally significant in confirming the infection, although 78% of the gastric/duodenal samples have returned positive. Perhaps the reason for the lower incidence of positive peritoneal URT is the lowest density of bacteria at this site or some other factor such as omentum blockade, which, given their immunological capacity, would affect the sampling 11,12 . The primary closure with interposition of an omental patch over the perforation has been the procedure most frequently performed since its popularization by Graham in 1937 3,13,14 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Análise epidemiológica e emprego do teste rápido da urease em pacientes com úlcera péptica perfurada

Casali¹,

Franzon

Kruel

et al. 2012

Rev. Col. Bras. Cir.

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OBJETIVO: Analisar o perfil epidemiológico de pacientes com úlcera péptica gastroduodenal perfurada e verificar se a presença do H. pylori nas secreções peritoneais e intraluminais desses pacientes pode ser avaliada pelo teste rápido da urease. MÉTODOS: Realizou-se estudo prospectivo, transversal, descritivo, com dados de pacientes atendidos em um hospital de abrangência regional, em portadores de úlcera péptica perfurada. Coletou-se, no transoperatório, amostras de líquido peritoneal (na proximidade da perfuração) e da secreção intraluminal, sendo encaminhadas para cultura e teste rápido de urease. RESULTADOS: Quatorze pacientes foram analisados. A média etária foi 41,06 anos, todos homens, brancos (71,4%), tabagistas (57,2%), IMC < 30 (85,7%), com história prévia de dispepsia (78,6%). Sorologia para H. pylori foi positiva em 84,6% dos casos. O teste rápido da urease foi positivo em 78,6% das amostras do tubo digestivo e em 42,8% das amostras da cavidade peritoneal; 41,6% foram positivos em ambos os locais, 50% somente na cavidade digestiva e 8,4% exclusivamente na cavidade peritoneal. Dos 11 pacientes com sorologia positiva para H. pylori 100% apresentaram positividade em pelo menos um dos sítios pesquisados. CONCLUSÃO: Verificou-se que a incidência foi menor que a esperada. Há associação significativa entre a infecção pelo H. pylori e a ocorrência de perfuração. A presença deste patógeno pode ser avaliada tanto pela sorologia quanto pela realização do teste rápido da urease do fluido coletado na cavidade peritoneal e na luz gástrica/duodenal.

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Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer

Abstract: 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.

Cited by 40 publications

References 21 publications

Mechanisms of Mortality in Early and Late Sepsis

Mechanisms of Mortality in Early and Late Sepsis

Incidence and Significance of Intra-Operative Peritoneal Fluid Fungal Culture in Patients of Perforated Peptic Ulcers

Análise epidemiológica e emprego do teste rápido da urease em pacientes com úlcera péptica perfurada

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