Role of Empiric Antifungal Therapy in Patients with Perforated Peptic Ulcers

Majid Chammas, Khaled Abdul Jawad, Rebecca A. Saberi, Gareth Gilna, Eva M. Urrechaga, Alessia Cioci, Rishi Rattan, Gerd Daniel Pust, Nicholas Namias, Daniel Dante Yeh

Research output: Contribution to journalArticlepeer-review

Abstract

Background: 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. Patients and Methods: 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"). Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)174-177
Number of pages4
JournalSurgical infections
Volume23
Issue number2
DOIs
StatePublished - Mar 2022
Externally publishedYes

Keywords

  • antifungal therapy
  • antimicrobial stewardship
  • perforated peptic ulcers

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

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