Antifungal Interventions in Gastrointestinal Pathologies

Fungal pathogens, notably Candida species, have emerged as significant contributors to complications in gastrointestinal surgery and disease. Disruption of mucosal barriers, immunosuppression and broad‐spectrum antibiotic use create a permissive environment for fungal overgrowth and invasive infection. Perforated peptic ulcers, secondary peritonitis, anastomotic leaks and high‐level hepatopancreatobiliary procedures are particularly prone to fungal contamination, which carries a marked increase in morbidity and mortality. Clinical strategies range from prophylactic administration in high‐risk cohorts to empiric treatment at the onset of sepsis and culture‐directed therapy once fungal pathogens are identified. Advances in diagnostic biomarkers and rapid molecular assays have improved the distinction between mere colonisation and true invasive disease, facilitating targeted antifungal regimens. First‐line agents now include echinocandins alongside triazoles, with dosing guided by pharmacokinetic monitoring. Despite these developments, practice remains heterogeneous across regions and institutions. An integrated approach involving surgical, infectious disease and critical care teams is essential to optimise patient selection, minimise unnecessary exposure and enhance outcomes in global health settings.

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Antifungal Interventions in Gastrointestinal Pathologies publication trend

The graph below shows the total number of articles in antifungal interventions in gastrointestinal pathologies across all publications each year (not limited to Nature Index journals).

Technical terms

Empiric antifungal therapy: Initiation of antifungal treatment based on clinical risk factors and presentation prior to pathogen identification.

Culture-directed therapy: Antifungal regimen selected according to microbiological culture results and susceptibility profiles.

Fungal colonisation: Presence of fungi on mucosal or tissue surfaces without evidence of tissue invasion or systemic disease.

Invasive fungal infection: Penetration of fungi into normally sterile host tissues, causing symptomatic disease.

Biomarker: A measurable biological molecule indicating the presence or severity of a fungal infection, used to guide therapy.

References

1. Should Empiric Anti-Fungals Be Administered Routinely for All Patients with Perforated Peptic Ulcers? A Critical Review of the Existing Literature. Pathogens (2024).
2. Antifungal Use in Perforated Peptic Ulcer Disease: A Western Australian Perspective. Cureus (2024).
3. Association between gastric Candida colonization and surgical site infections after high-level hepatobiliary pancreatic surgeries: the results of prospective observational study. Langenbeck's Archives of Surgery (2020).