Yoav Bichovsky1, Leonid Koyfman1, Michael Friger2, Boris Kirshtein3, Abraham Borer4, Gilbert Sebbag5, Dmitry Frank1, Amit Frenkel1, Jochanan G Peiser6, Moti Klein1, Evgeni Brotfain7. 1. Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 2. Health Science Faculty, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 3. Department of General Surgery A, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 4. Department of Infectious Diseases, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 5. Department of General Surgery B, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 6. Department of Medical Management, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 7. Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. bem1975@gmail.com.
Abstract
PURPOSE: Peritonitis is a major complication of bariatric surgery due to direct damage to the natural barriers to infection. Most such secondary peritoneal infections are caused by Gram-negative microorganisms; however, under certain conditions, Candida species can infect the peritoneal cavity following bariatric surgery. MATERIALS AND METHODS: We retrospectively analyzed the clinical and microbiological data of morbidly obese patients who suffered infectious complications following laparoscopic sleeve gastrectomy (LSG) at the Soroka Medical Center between January 2010 and June 2015. RESULTS: Out of 800 patients who underwent LSG, 43 (5.3%( developed secondary peritonitis and were admitted to our General Intensive Care Unit during the study period. Intraperitoneal leaks, intraabdominal abscesses and pleural effusions were significantly more common in patients with fungal infection than in those with non-fungal infections (p values 0.027, < 0.001, and < 0.014, respectively). Leaks situated at the suture line of gastro-esophageal area occurred much more frequently in the fungal infection group than in the non-fungal infection group (94.7 vs 41.7%, p < 0.001). Microbiological analysis of the abdominal and pleural fluids of patients with invasive fungal infectious complications showed the presence of commensal polymicrobial bacterial infections-mainly Streptoccocus constellatus and coagulase negative Staphylococcus spp. Leakage at the suture line of gastro-esophageal area (upper suture part) and administration of parenteral nutrition were found to be independent predictors for invasive fungal infections after LSG. CONCLUSION: Our study demonstrates that invasive fungal infection is a significant postoperative infectious complication of bariatric LSG surgery in morbidly obese patients.
PURPOSE: Peritonitis is a major complication of bariatric surgery due to direct damage to the natural barriers to infection. Most such secondary peritoneal infections are caused by Gram-negative microorganisms; however, under certain conditions, Candida species can infect the peritoneal cavity following bariatric surgery. MATERIALS AND METHODS: We retrospectively analyzed the clinical and microbiological data of morbidly obesepatients who suffered infectious complications following laparoscopic sleeve gastrectomy (LSG) at the Soroka Medical Center between January 2010 and June 2015. RESULTS: Out of 800 patients who underwent LSG, 43 (5.3%( developed secondary peritonitis and were admitted to our General Intensive Care Unit during the study period. Intraperitoneal leaks, intraabdominal abscesses and pleural effusions were significantly more common in patients with fungal infection than in those with non-fungal infections (p values 0.027, < 0.001, and < 0.014, respectively). Leaks situated at the suture line of gastro-esophageal area occurred much more frequently in the fungal infection group than in the non-fungal infection group (94.7 vs 41.7%, p < 0.001). Microbiological analysis of the abdominal and pleural fluids of patients with invasive fungal infectious complications showed the presence of commensal polymicrobial bacterial infections-mainly Streptoccocus constellatus and coagulase negative Staphylococcus spp. Leakage at the suture line of gastro-esophageal area (upper suture part) and administration of parenteral nutrition were found to be independent predictors for invasive fungal infections after LSG. CONCLUSION: Our study demonstrates that invasive fungal infection is a significant postoperative infectious complication of bariatric LSG surgery in morbidly obesepatients.
Authors: Michel Gagner; Mervyn Deitel; Traci L Kalberer; Ann L Erickson; Ross D Crosby Journal: Surg Obes Relat Dis Date: 2009-06-13 Impact factor: 4.734
Authors: Matteo Bassetti; Monia Marchetti; Arunaloke Chakrabarti; Sergio Colizza; Jose Garnacho-Montero; Daniel H Kett; Patricia Munoz; Francesco Cristini; Anastasia Andoniadou; Pierluigi Viale; Giorgio Della Rocca; Emmanuel Roilides; Gabriele Sganga; Thomas J Walsh; Carlo Tascini; Mario Tumbarello; Francesco Menichetti; Elda Righi; Christian Eckmann; Claudio Viscoli; Andrew F Shorr; Olivier Leroy; George Petrikos; Francesco Giuseppe De Rosa Journal: Intensive Care Med Date: 2013-10-09 Impact factor: 17.440