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Empiric Antifungal Therapy Is Not Associated with Improved Infectious Outcomes in Penetrating Upper Gastrointestinal
Vahe S Panossian1, Yasmin Arda1, Wardah Rafaqat2
1Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Background:
The role of empiric antifungal therapy in patients with gastrointestinal (GI) perforations because of penetrating trauma remains unclear. Existing literature suggests minimal benefit in non-traumatic GI perforations. This study aimed to evaluate the association between empiric antifungal use and post-operative infectious complications in patients with upper GI perforations because of penetrating trauma.
Methods:
This was a prospective, multi-center cohort study conducted across 15 institutions between August 2021 and January 2024. We included adult patients with upper GI perforations because of penetrating trauma. The primary outcome was organ/space surgical site infection (SSI) within 30 days. Secondary outcomes included superficial and deep SSI, any SSI (superficial, deep, or organ/space), sepsis, pneumonia, return to the operating room, acute kidney injury (AKI), and in-hospital mortality. Multi-variable logistic regression was used to adjust for confounders.
Results:
A total of 173 patients were included, of whom 23.1% (n = 40) received empiric antifungals. There was no significant difference in the rate of organ/space SSI between patients who received antifungals and those who did not (17.5% vs. 9.8%, p = 0.180). Antifungal use was also not associated with any significant difference in superficial, deep, or any SSI rates. On multi-variable analysis, antifungal therapy was not independently associated with reduced risk of organ/space SSI (odds ratio 1.72, 95% confidence interval 0.58-5.07). Patients who received antifungals had higher rates of sepsis, pneumonia, AKI, return to the operating room, and in-hospital mortality.
Conclusions:
Empiric antifungal therapy was not associated with a reduction in organ/space SSI or any SSI, among patients with penetrating upper GI injuries. Trauma patients with upper GI injuries do not appear to benefit from empiric antifungal coverage.
Insights
Empiric antifungal therapy did not reduce surgical site infections in trauma patients with gastrointestinal perforations. Antifungal use was not beneficial and associated with worse outcomes in these patients.
Area of Science:
- Trauma surgery
- Infectious disease
- Gastrointestinal surgery
Background:
- The efficacy of empiric antifungal therapy in patients with gastrointestinal (GI) perforations due to penetrating trauma is not well-established.
- Previous research indicates limited benefit in non-traumatic GI perforations.
- This study investigates the impact of empiric antifungal use on post-operative infectious complications in penetrating upper GI trauma.
Purpose of the Study:
- To evaluate the association between empiric antifungal therapy and organ/space surgical site infections (SSI) in patients with penetrating upper GI trauma.
- To assess the effect of antifungal use on other infectious complications and mortality.
- To determine if empiric antifungals offer a protective benefit in this specific patient population.
Main Methods:
- Prospective, multi-center cohort study involving 15 institutions.
- Inclusion of adult patients with upper GI perforations from penetrating trauma.
- Primary outcome: organ/space SSI within 30 days; secondary outcomes: various SSIs, sepsis, pneumonia, reoperation, acute kidney injury (AKI), and mortality.
- Statistical analysis using multi-variable logistic regression to control for confounders.
Main Results:
- A total of 173 patients were analyzed; 23.1% received empiric antifungals.
- No significant difference in organ/space SSI rates between antifungal and no-antifungal groups (17.5% vs. 9.8%, p=0.180).
- Antifungal therapy was not independently associated with reduced organ/space SSI risk (OR 1.72).
- Patients receiving antifungals showed higher rates of sepsis, pneumonia, AKI, return to OR, and in-hospital mortality.
Conclusions:
- Empiric antifungal therapy does not decrease the incidence of organ/space SSI or any SSI in patients with penetrating upper GI injuries.
- Trauma patients with upper GI injuries do not appear to benefit from empiric antifungal coverage.
- Antifungal use in this cohort was associated with increased adverse outcomes.
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