From the Research
Peritoneal fungal infections occur in approximately 5.3% of patients following abdominal surgery, as seen in a study of laparoscopic sleeve gastrectomy patients 1. The most common causative organism is Candida species, particularly Candida albicans. Patients with recent antibiotic use, diabetes, immunosuppression, or those undergoing emergency procedures have higher infection rates, potentially reaching 10-15% 2, 3. Early diagnosis is challenging as symptoms often mimic bacterial peritonitis, including fever, abdominal pain, and elevated inflammatory markers. Treatment typically involves systemic antifungal therapy with echinocandins (such as caspofungin 70mg loading dose followed by 50mg daily) or fluconazole (400-800mg daily) for 2-4 weeks, depending on the severity and patient response 4, 3. Surgical intervention may be necessary to remove infected material or drain abscesses. Mortality rates from fungal peritonitis remain significant at 20-30%, highlighting the importance of early recognition and aggressive management, particularly in high-risk surgical patients 5, 3. Preventive strategies include judicious antibiotic use, strict perioperative glycemic control, and consideration of antifungal prophylaxis in selected high-risk patients 5. Some studies suggest that leakage at the suture line of gastro-esophageal area and administration of parenteral nutrition are independent predictors for invasive fungal infections after laparoscopic sleeve gastrectomy 1. The management of fungal peritonitis poses a difficult challenge, and prompt initiation of therapy is critical, but no typical clinical picture has emerged, and the infecting organism can be difficult to isolate 3. The approach to the disease has changed considerably in recent years, and the guidelines from the International Society for Peritoneal Dialysis list fungal peritonitis as a strong indication for immediate catheter removal with temporary hemodialysis 3. The conventional antifungal regimens include fluconazole, amphotericin B, and flucytosine alone or in combination, optimally based on fungal sensitivities 4, 3. The newer agents such as caspofungin and voriconazole have the potential to alter treatment strategies for fungal peritonitis, but further studies are required to clarify the precise role of these agents in this group of patients 3. In summary, peritoneal fungal infections are a significant complication of abdominal surgery, and early recognition and aggressive management are crucial to improve patient outcomes.