RT Journal Article
SR Electronic
T1 Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000662
DO 10.1136/tsaco-2020-000662
VO 6
IS 1
A1 Galinos Barmparas
A1 Adel Alhaj Saleh
A1 Raymond Huang
A1 Barbara C Eaton
A1 Brandon R Bruns
A1 Alexander Raines
A1 Cressilee Bryant
A1 Christopher E Crane
A1 Elizabeth P Scherer
A1 Thomas J Schroeppel
A1 Eliza Moskowitz
A1 Justin L Regner
A1 Richard Frazee
A1 Eric M Campion
A1 Matthew Bartley
A1 Jared R Mortus
A1 Jeremy Ward
A1 Daniel R Margulies
A1 Sharmila Dissanaike
YR 2021
UL http://tsaco.bmj.com/content/6/1/e000662.abstract
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.