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Role of Empiric Antifungal Therapy in Patients with Perforated Peptic Ulcers
Majid Chammas1, Khaled Abdul Jawad1, Rebecca A Saberi1
1Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami, Jackson Memorial Hospital Ryder Trauma Center, Miami, Florida, USA.
Abstract:
It is unclear if the addition of antifungal therapy for perforated peptic ulcers (PPU) leads to improved outcomes. We hypothesized that empiric antifungal therapy is associated with better clinical outcomes in critically ill patients with PPU. The 2001-2012 Medical Information Mart for Intensive Care (MIMIC-III) database was searched for patients with PPU and the included subjects were divided into two groups depending on receipt of antifungal therapy. Propensity score matching by surgical intervention, mechanical ventilation (MV), and vasopressor administration was then performed and clinically important outcomes were compared. Multiple logistic regression was performed to calculate the odds of a composite end point (defined as "alive, hospital-free, and infection-free at 30 days"). A total of 89 patients with PPU were included, of whom 52 (58%) received empiric antifungal therapy. Propensity score matching resulted in 37 pairs. On logistic regression controlling for surgery, vasopressors, and MV, receipt of antifungal therapy was not associated with higher odds (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.5-4.7; p = 0.4798) of the composite end point. In critically ill patients with perforated peptic ulcer, receipt of antifungal therapy, regardless of surgical intervention, was not associated with improved clinical outcomes. Selection bias is possible and therefore randomized controlled trials are required to confirm/refute causality.
Insights
Empiric antifungal therapy did not improve outcomes for critically ill patients with perforated peptic ulcers (PPU). Further research, such as randomized controlled trials, is needed to confirm these findings.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Infectious Diseases
Background:
- Perforated peptic ulcers (PPU) are a serious condition, particularly in critically ill patients.
- The role of antifungal therapy in managing PPU remains unclear.
- This study investigates the impact of empiric antifungal therapy on clinical outcomes in PPU patients.
Purpose of the Study:
- To determine if empiric antifungal therapy improves clinical outcomes in critically ill patients with PPU.
- To analyze the association between antifungal administration and a composite endpoint of survival, hospital-free days, and infection-free status at 30 days.
Main Methods:
- Retrospective analysis of 89 critically ill PPU patients from the MIMIC-III database (2001-2012).
- Patients were divided into those who received antifungal therapy and those who did not.
- Propensity score matching was used to control for surgical intervention, mechanical ventilation, and vasopressor use, followed by logistic regression analysis.
Main Results:
- 58% of PPU patients received empiric antifungal therapy.
- After propensity score matching (37 pairs), antifungal therapy was not significantly associated with improved odds of the composite endpoint (OR, 1.5; 95% CI, 0.5-4.7).
- Logistic regression controlling for key variables also showed no significant benefit.
Conclusions:
- Empiric antifungal therapy does not appear to improve clinical outcomes in critically ill patients with perforated peptic ulcers.
- The findings suggest that antifungal use may not be beneficial, irrespective of surgical intervention.
- Randomized controlled trials are necessary to establish causality and confirm these results, given potential selection bias.
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