Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation
Recommended Citation
Gochi AM, Rafaqat W, Panossian V, Ghneim M, Anandalwar S, Argandykov D, Susai CJ, Alcasid NJ, Anderson GA, Ordoobadi AJ, Teicher EJ, Blake DP, Beaulieu-Jones BR, Sanchez SE, Guidry CA, Teixeira P, Meizoso J, Collie BL, McWilliam S, McGonagill P, Nitschke N, Kortlever T, Galet C, Nefcy LA, Johnson JL, DeWane MP, Cuschieri J, Himmler A, Rickard J, Gipson J, and Mendoza AE. Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation. Surg Infect (Larchmt) 2025.
Document Type
Article
Publication Date
5-13-2025
Publication Title
Surgical infections
Abstract
Background: Empiric anti-fungals are frequently administered in patients with non-colonic gastrointestinal (GI) perforations, but there is limited evidence of their benefit. We hypothesized that empiric anti-fungals would offer no clinical benefit compared with a standard course of antimicrobial therapy.
Methods: This multi-center prospective cohort study included patients ≥ 18 years old undergoing operative management for non-colonic GI perforations across 15 centers between August 2021 and January 2024. The primary outcome was organ-space surgical site infection (SSI). We performed propensity score matching to adjust for confounders and a backward stepwise regression model to identify predictors of an organ-space SSI. A subgroup analysis of spontaneous upper GI perforations was performed as well.
Results: A total of 192 patients were included; 138 (71.88%) received empiric anti-fungal therapy, and 17.7% developed an organ-space SSI. Before matching, empiric anti-fungal use was frequent in critically ill patients although not associated with organ-space SSI. After matching, there were no differences in organ-space SSI (17.5% vs. 17.5%, p = 0.99). In multi-variable regression, American Society of Anesthesiologists physical status classification system (ASA) category 3 increased the risk of organ-space SSI (odds ratio [OR] 2.49, p = 0.04), whereas perioperative proton-pump inhibitor (PPI) use was protective (OR 0.15, p = 0.004). In the subgroup analysis (N = 150), empiric anti-fungal therapy did not reduce infection risk. Pre-operative shock increased the risk of organ-space SSI (OR 2.83, p = 0.04), whereas PPI use remained protective (OR 0.15, p = 0.01).
Conclusion: Empiric anti-fungal use was not associated with reduced organ-space SSI, even after adjusting for confounders. Given the lack of benefit, we caution against the use of routine empiric anti-fungal therapy in non-colonic GI perforations.
Medical Subject Headings
anti-fungal; antimicrobial; empiric antimicrobial therapy; gastrointestinal perforation; intra-abdominal infection
PubMed ID
40358474
ePublication
ePub ahead of print
Volume
26
Issue
8
First Page
618
Last Page
626
