Surgical infections · 2026
Empiric Antifungal Therapy Is Not Associated with Improved Infectious Outcomes in Penetrating Upper Gastrointestinal Injuries: A Subgroup Analysis of the Surgical Infection Society Multi-Center Observational Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Panossian Vahe S, Arda Yasmin, Rafaqat Wardah, Gochi Andrea M, Ghneim Mira, Anandalwar Seema, Argandykov Dias, Susai Cynthia, Alcasid Nathan, Anderson Geoffrey A, Ordoobadi Alexander J, Teicher Erik J, Blake David P, Beaulieu-Jones Brendin R, Sanchez Sabrina E, Guidry Christopher A, Teixeira Pedro, Meizoso Jonathan, Collie Brianna L, McWilliam Sarah, McGonagill Patrick, Nitschke Nicole, Galet Colete, Nefcy Lillian, Johnson Jeffrey L, DeWane Michael P, Cuschieri Joseph, Himmler Amber, Rickard Jennifer, Gipson Jonathan, Mendoza April E
Аннотация
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.
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.