Research Article Invasive Candida Infection after Upper Gastrointestinal Tract Surgery for Gastric Cancer Evgeni Brotfain, 1 Gilbert Sebbag, 2 Michael Friger, 3 Boris Kirshtein, 4 Abraham Borer, 5 Leonid Koyfman, 1 Dmitry Frank, 1 Yoav Bichovsky, 1 Jochanan G. Peiser, 6 and Moti Klein 1 1 Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel 2 Department of General Surgery B, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel 3 Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel 4 Department of General Surgery A, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel 5 Department of Infectious Disease, 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 Correspondence should be addressed to Evgeni Brotfain; bem1975@gmail.com Evgeni Brotfain and Gilbert Sebbag contributed equally to this work. Received 4 June 2017; Revised 3 September 2017; Accepted 10 October 2017; Published 6 November 2017 Academic Editor: S. Curley Copyright © 2017 Evgeni Brotfain et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Upper gastrointestinal tract (GIT) surgical procedures are more likely to cause nosocomial Candida peritonitis than lower GIT procedures and they thus constitute an independent risk factor for mortality. Because of the severity of postsurgical fungal infections complications, intensivists and surgeons need to be extremely aware of their clinical importance in critically ill postsurgical intensive care unit (ICU) patients. We analyzed the clinical and microbiological data of 149 oncologic patients who were hospitalized in the ICU at Soroka Medical Center between January 2010 and January 2015 afer undergoing upper GIT surgery for gastric cancer. Invasive fungal infections related to secondary peritonitis following oncologic upper GIT surgery had a higher mortality rate than patients with nonfungal postoperative infectious complications. Te presence of gastroesophageal junction leakage and advanced age were found to be independent risk factors for invasive fungal infection afer oncologic upper GIT surgery. 1. Introduction Gastrointestinal tract (GIT) surgery is a major risk factor for secondary peritonitis [1]. Surgical intervention causes this complication by altering the physiologic fora of the GIT and by directly damaging the natural barriers of infection [2]. In the wake of surgical intervention, the GIT is most ofen colonized by Gram-negative invasive microorganisms. However, under certain postsurgical conditions Candida fungi are liable to colonize the peritoneal cavity and cause infection [3]. It is known that upper GIT surgical procedures are more likely to cause nosocomial Candida peritonitis than lower GIT procedures [1, 4–6] and consequently upper GIT surgery constitutes an independent risk factor for mortality [4]. Underlying comorbidities, such as immunosuppression, cancer, the frequently malnourished state of critical care patients, administration of total parenteral nutrition (TPN), and use of intravenous catheters, are additional factors that tend to increase the frequency of Candida colonization and peritonitis in oncologic surgical patients undergoing upper GIT surgery [7, 8]. All the above factors when present in oncologic surgical patients undergoing upper GIT surgery signifcantly increase their risk for developing intra-abdominal Candida infections. Importantly, the over- all mortality rate is much higher in surgical critically ill patients with intra-abdominal Candida infections than in those with purely bacterial infections [9, 10]. Furthermore, postsurgical patients who are critically ill with fungal or nonfungal secondary generalized peritonitis ofen require repeated laparotomies, which in turn are associated with Hindawi International Journal of Surgical Oncology Volume 2017, Article ID 6058567, 7 pages https://doi.org/10.1155/2017/6058567