Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations

Crit Care Med. 2002 Mar;30(3):541-7. doi: 10.1097/00003246-200203000-00008.


Objective: Determine the significance of recovering yeasts from intraoperative specimens from the abdominal cavity and to evaluate the effect of a single intraoperative dose of fluconazole on clinical outcome in patients with intra-abdominal perforations.

Design: Prospective, randomized, double-blind study.

Setting: Multicenter study from 13 hospitals in Norway.

Patients: One hundred nine patients with intra-abdominal perforations.

Interventions: Patients were randomized to receive either a single 400-mg fluconazole dose or placebo during the operation.

Measurements and main results: An intra-abdominal specimen for microbiological culture was obtained at the time of the operation. The primary response variable in the study was death. Secondary response variables were three parameters indicating a complicated postoperative period: mechanical ventilation for > or = 5 days, intensive care treatment for > or = 10 days, and use of a central venous catheter for > or = 10 days. Yeasts were recovered from a intraoperative intra-abdominal specimen from only 1 (3.5%) of 28 patients with perforated appendicitis and from 32 (39.5%) of 81 nonappendicitis patients. Excluding the appendicitis patients, the yeast recovery rate was high both for patients hospitalized at the time of the perforation (45%) and for nonhospitalized patients (32%). The overall mortality was 11% (12 patients). Single-dose intraoperative fluconazole prophylaxis did not reach a statistically significant effect on mortality (4 of 53 patients in the fluconazole group and 8 of 56 patients in the placebo group died [p = .059]). The only two explanatory variables significantly related to death were a intraoperative finding of yeast from an intra-abdominal specimen and the occurrence of a spontaneous perforation in a patient already hospitalized for nonsurgical cancer treatment. Detection of yeast was also a significant explanatory variable for a prolonged period of mechanical ventilation, intensive care treatment, and prolonged use of a central venous catheter.

Conclusions: Single-dose intraoperative fluconazole prophylaxis did not have a statistically significant effect on overall mortality (odds ratio = 0.21; 95% confidence interval, 0.04-1.06; p = .059) in patients with intra-abdominal perforation. The recovery rate of yeast from intraoperative specimens from the abdominal cavity was high (>30%) and was associated with death and a complicated postoperative course.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / therapeutic use*
  • Candidiasis / complications*
  • Candidiasis / drug therapy*
  • Candidiasis / microbiology
  • Double-Blind Method
  • Female
  • Fluconazole / therapeutic use*
  • Humans
  • Intestinal Perforation / microbiology*
  • Intestinal Perforation / mortality
  • Intestinal Perforation / surgery
  • Intraoperative Care
  • Male
  • Middle Aged
  • Norway / epidemiology
  • Peritonitis / epidemiology
  • Peritonitis / microbiology
  • Peritonitis / prevention & control
  • Postoperative Complications / epidemiology
  • Postoperative Complications / microbiology
  • Postoperative Complications / prevention & control
  • Prognosis
  • Risk
  • Rupture
  • Stomach Diseases / microbiology*
  • Stomach Diseases / mortality
  • Stomach Diseases / surgery


  • Antifungal Agents
  • Fluconazole