Gastric Candida Colonization Linked to Surgical Site Infections After Complex HBP Surgery

Overview

This prospective observational study of 66 patients undergoing high-level hepatobiliary pancreatic (HBP) surgeries found that gastric Candida colonization is significantly associated with increased surgical site infections (SSIs). The presence of gastric Candida was identified as an independent risk factor for SSIs, highlighting its potential role in postoperative infectious complications.

Background

High-level HBP surgeries such as pancreaticoduodenectomy and major hepatectomy carry high morbidity and mortality rates, largely due to postoperative infectious complications including pancreatic fistula, biliary fistula, intra-abdominal abscess, and wound infections. Previous studies have linked bacterial colonization, especially bacteriobilia from preoperative biliary drainage, to these infections. Candida species, commonly colonizing the gastrointestinal tract, can become invasive postoperatively, but the impact of gastric Candida colonization on postoperative infections in HBP surgeries has not been well studied. This study aimed to clarify the influence of gastric Candida colonization on SSIs in this surgical population.

Data Highlights

Key Findings

• Gastric Candida colonization was detected by culturing gastric juice collected immediately after anesthesia induction.
• Patients with gastric Candida colonization had a significantly higher incidence of surgical site infections compared to those without colonization.
• Gastric Candida colonization was identified as an independent risk factor for postoperative SSIs after high-level HBP surgeries.
• Preoperative biliary drainage and broad-spectrum antibiotic use were evaluated as potential risk factors for gastric Candida colonization.
• Despite prophylactic antibiotic use, antifungal therapy was not administered, suggesting colonization rather than overt infection was present preoperatively.

Clinical Implications

Clinicians should consider the presence of gastric Candida colonization as a potential contributor to postoperative infectious complications in patients undergoing complex HBP surgeries. Preoperative assessment of gastric fungal colonization may help identify patients at higher risk for SSIs, potentially guiding targeted prophylactic or therapeutic strategies. Further research is warranted to evaluate whether antifungal prophylaxis could reduce SSIs in this population.

Conclusion

Gastric Candida colonization is a significant and independent risk factor for surgical site infections following complex hepatobiliary pancreatic surgeries. Recognizing and addressing this colonization may improve postoperative outcomes.

References

1. Mie University Hospital Study 2016-2017 -- Link Between Gastric Candida Presence and Surgical Site Infections Following Complex Hepatobiliary Pancreatic Procedures