Detection of Candida spp. from peritoneal swabs indicate worse outcome in patients with perforated peptic ulcer: revisiting a longstanding debate

Abstract Purpose The purpose of this study was to evaluate the outcome of patients with perforated peptic ulcer, stratified by detection of Candida spp. from peritoneal swabs. Methods A retrospective, single-center, observational study was performed. All adult patients with perforated peptic ulcer who underwent surgical therapy were included. Candida spp. detection was defined as the result of culture incubation from peritoneal swabs at the index surgery. Its association with postoperative complications and in-hospital mortality was analyzed. Results A total of 187 adult patients were included. Intraperitoneal pathogens were detected by microbiological analysis in 96 patients (61.9%). Candida spp. were detected in 62 patients (39.4%), of whom 23 (37.7%) received antifungal therapy. Patients with peritoneal detection of Candida spp. had an increased in-hospital mortality (OR 5.80, 95% CI 1.96–16.97, p < 0.001), and an increased rate of Clavien-Dindo grade III or higher complications (OR 6.08, 95% CI 2.95–12.54, p < 0.001), suture dehiscence (p = 0.003), and longer hospital stays (p = 0.002). The multivariable analysis revealed that severe complications (OR: 8.83; 95% CI: 3.19–24.46; p < 0.001) and in-hospital mortality (OR: 4.81; 95% CI: 1.16–19.90; p = 0.030) were significantly more prevalent among patients with peritoneal detection of Candida spp. Conclusion Intraperitoneal presence of Candida spp. is associated with increased morbidity and mortality in patients with perforated peptic ulcer.