Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients

Area of Science:

• Medical Mycology
• Infectious Diseases
• Surgical Infections

Background:

• The role of empiric antifungals for post-surgical abscesses (PSAs) lacks clear international guidelines, which primarily focus on invasive mycoses in bloodstream infections.
• Empiric antifungal administration practices for PSAs are often controversial and may not align with established risk factors for fungal infections.

Purpose of the Study:

• To analyze factors associated with empiric antifungal administration in patients with PSAs.
• To compare these factors with those associated with actual fungal isolation from abdominal abscesses.
• To evaluate the consistency of current empiric antifungal therapy criteria with fungal infection risk factors.

Main Methods:

• Retrospective cohort study of 319 patients with PSAs at an Italian tertiary hospital (2013-2018).
• Analysis of factors linked to empiric antifungal use (primarily azoles) and fungal (Candida) isolation.
• Multivariate and univariate analyses to identify associated risk factors.

Main Results:

• 14.4% of patients received empiric antifungals; 10.7% had Candida isolated, always with bacteria.
• Empiric antifungal use was associated with upper GI surgery, recent ICU stay, and early reintervention.
• Pancreas/biliary tract surgery correlated with fungal isolation, while lower GI surgery showed a protective effect.

Conclusions:

• Current criteria for empiric antifungal therapy in post-surgical abscesses appear inconsistent with identified risk factors for fungal isolation.
• There is a need for wider studies to develop evidence-based guidance for empiric antifungal treatment in PSAs.