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    Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer

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    Author
    Barmparas, Galinos
    Alhaj Saleh, Adel
    Huang, Raymond
    Eaton, Barbara C.
    Bruns, Brandon R.
    Raines, Alexander
    Bryant, Cressilee
    Crane, Christopher E.
    Scherer, Elizabeth P.
    Schroeppel, Thomas J.
    Moskowitz, Eliza
    Regner, Justin L.
    Frazee, Richard
    Campion, Eric M.
    Bartley, Matthew
    Mortus, Jared R.
    Ward, Jeremy
    Margulies, Daniel R.
    Dissanaike, Sharmila
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    Date
    2021-05-19
    Journal
    Trauma Surgery and Acute Care Open
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1136/tsaco-2020-000662
    Abstract
    Introduction Infection control in patients with perforated peptic ulcers (PPU) commonly includes empiric antifungals (AF). We investigated the variation in the use of empiric AF and explored the association between their use and the subsequent development of organ space infection (OSI). Methods This was a secondary analysis of a multicenter, case-control study of patients treated for PPU at nine institutions between 2011 and 2018. Microbiology and utilization of empiric AF, defined as AF administered within 24 hours from the index surgery, were recorded. Patients who received empiric AF were compared with those who did not. The primary outcome was OSI and secondary outcome was OSI with growth of Candida spp. A logistic regression was used to adjust for differences between the two cohorts. Results A total of 554 patients underwent a surgical procedure for PPU and had available timing of AF administration. The median age was 57 years and 61% were male. Laparoscopy was used in 24% and omental patch was the most common procedure performed (78%). Overall, 239 (43%) received empiric AF. There was a large variation in the use of empiric AF among participating centers, ranging from 25% to 68%. The overall incidence of OSI was 14% (77/554) and was similar for patients who did or did not receive empiric AF. The adjusted OR for development of OSI for patients who received empiric AF was 1.04 (95% CI 0.64 to 1.70), adjusted p=0.86. The overall incidence of OSI with growth of Candida spp was 5% and was similar for both groups (adjusted OR 1.29, 95% CI 0.59 to 2.84, adjusted p=0.53). Conclusion For patients undergoing surgery for PPU, the use of empiric AF did not yield any significant clinical advantage in preventing OSI, even those due to Candida spp. Use of empiric AF in this setting is unnecessary. Study type Original article, case series. Level of evidence III.
    Keyword
    Candida
    fluconazole
    infections
    postoperative complications
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/15922
    ae974a485f413a2113503eed53cd6c53
    10.1136/tsaco-2020-000662
    Scopus Count
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