PT - JOURNAL ARTICLE AU - Galinos Barmparas AU - Adel Alhaj Saleh AU - Raymond Huang AU - Barbara C Eaton AU - Brandon R Bruns AU - Alexander Raines AU - Cressilee Bryant AU - Christopher E Crane AU - Elizabeth P Scherer AU - Thomas J Schroeppel AU - Eliza Moskowitz AU - Justin L Regner AU - Richard Frazee AU - Eric M Campion AU - Matthew Bartley AU - Jared R Mortus AU - Jeremy Ward AU - Daniel R Margulies AU - Sharmila Dissanaike TI - Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer AID - 10.1136/tsaco-2020-000662 DP - 2021 May 01 TA - Trauma Surgery & Acute Care Open PG - e000662 VI - 6 IP - 1 4099 - http://tsaco.bmj.com/content/6/1/e000662.short 4100 - http://tsaco.bmj.com/content/6/1/e000662.full SO - Trauma Surg Acute Care Open2021 May 01; 6 AB - Introduction Infection control in patients with perforated peptic ulcers (PPU) commonly includes empiric antifungals (AF). We investigated the variation in the use of empiric AF and explored the association between their use and the subsequent development of organ space infection (OSI).Methods This was a secondary analysis of a multicenter, case–control study of patients treated for PPU at nine institutions between 2011 and 2018. Microbiology and utilization of empiric AF, defined as AF administered within 24 hours from the index surgery, were recorded. Patients who received empiric AF were compared with those who did not. The primary outcome was OSI and secondary outcome was OSI with growth of Candida spp. A logistic regression was used to adjust for differences between the two cohorts.Results A total of 554 patients underwent a surgical procedure for PPU and had available timing of AF administration. The median age was 57 years and 61% were male. Laparoscopy was used in 24% and omental patch was the most common procedure performed (78%). Overall, 239 (43%) received empiric AF. There was a large variation in the use of empiric AF among participating centers, ranging from 25% to 68%. The overall incidence of OSI was 14% (77/554) and was similar for patients who did or did not receive empiric AF. The adjusted OR for development of OSI for patients who received empiric AF was 1.04 (95% CI 0.64 to 1.70), adjusted p=0.86. The overall incidence of OSI with growth of Candida spp was 5% and was similar for both groups (adjusted OR 1.29, 95% CI 0.59 to 2.84, adjusted p=0.53).Conclusion For patients undergoing surgery for PPU, the use of empiric AF did not yield any significant clinical advantage in preventing OSI, even those due to Candida spp. Use of empiric AF in this setting is unnecessary.Study type Original article, case series.Level of evidence III.Data are available upon reasonable request. Additional data from this study population are available to the participating centers in this multi-institutional trial.