Association between gastric Candida colonization and surgical site infections after high-level hepatobiliary pancreatic surgeries: the results of prospective observational study

Category	Detail
Condition	Gastric Candida colonization and its association with surgical site infections (SSIs) after high-level hepatobiliary pancreatic (HBP) surgeries
Key Mechanisms	Candida species colonize the upper gastrointestinal tract and may invade mucosal defects postoperatively, potentially increasing risk of SSIs through inapparent infection and fungal invasion
Target Population	Patients undergoing high-level HBP surgeries including pancreaticoduodenectomy, major hepatectomy, distal pancreatectomy, total pancreatectomy, and liver transplantation
Care Setting	Tertiary care hospital surgical units performing complex HBP procedures with perioperative antimicrobial prophylaxis

High-level HBP surgeries have significant postoperative infectious complications including pancreatic fistula, biliary fistula, intra-abdominal abscess, and wound infection.
Gastric Candida colonization is defined microbiologically by growth of Candida species on CHROMagar Candida plates from gastric juice collected intraoperatively.
Previous studies identified biliary candidiasis as an independent risk factor for SSIs; this study investigates the impact of gastric Candida colonization on postoperative infections.

Collect gastric juice immediately after anesthesia induction via nasogastric tube for Candida culture.
Use CHROMagar Candida plates to identify and quantify Candida species growth; define colonization as growth covering more than one quadrant.
Identify Candida species by colony color for species-specific recognition.

Administer prophylactic antibiotics perioperatively (e.g., flomoxef sodium) tailored to bile culture results.
No antifungal treatment was given regardless of gastric Candida colonization status in this study.
Perform intra-abdominal and wound irrigation before closure to reduce infection risk.

Monitor for postoperative infectious complications including SSIs, pancreatic and biliary fistulas, and intra-abdominal abscesses.
Observe microbiological cultures from bile and surgical sites to guide antibiotic therapy.

Gastric Candida colonization may increase risk of postoperative SSIs and invasive Candida infections.
Preoperative biliary drainage and broad-spectrum antibiotic use are associated with increased microbial colonization and infection risk.

66 patients undergoing high-level HBP surgeries at a single tertiary center

Standard perioperative antibiotic prophylaxis was used; antifungal agents were not administered despite presence of gastric Candida colonization.

Standardize surgical techniques and reconstruction methods to minimize infection risk.
Use intraoperative gastric juice culture to identify patients colonized with Candida species.
Tailor perioperative antibiotic therapy based on preoperative bile cultures to address bacterial pathogens.
Implement enhanced recovery protocols including carbohydrate-rich beverage preoperatively to reduce insulin resistance.
Perform thorough intra-abdominal and wound irrigation before closure to reduce microbial contamination.

Clinical Scorecard: Link Between Gastric Candida Presence and Surgical Site Infections Following Complex Hepatobiliary Pancreatic Procedures: Findings from a Prospective Observational Study