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dc.contributor.authorBarmparas, Galinos
dc.contributor.authorAlhaj Saleh, Adel
dc.contributor.authorHuang, Raymond
dc.contributor.authorEaton, Barbara C.
dc.contributor.authorBruns, Brandon R.
dc.contributor.authorRaines, Alexander
dc.contributor.authorBryant, Cressilee
dc.contributor.authorCrane, Christopher E.
dc.contributor.authorScherer, Elizabeth P.
dc.contributor.authorSchroeppel, Thomas J.
dc.contributor.authorMoskowitz, Eliza
dc.contributor.authorRegner, Justin L.
dc.contributor.authorFrazee, Richard
dc.contributor.authorCampion, Eric M.
dc.contributor.authorBartley, Matthew
dc.contributor.authorMortus, Jared R.
dc.contributor.authorWard, Jeremy
dc.contributor.authorMargulies, Daniel R.
dc.contributor.authorDissanaike, Sharmila
dc.date.accessioned2021-06-07T14:11:47Z
dc.date.available2021-06-07T14:11:47Z
dc.date.issued2021-05-19
dc.identifier.urihttp://hdl.handle.net/10713/15922
dc.description.abstractIntroduction 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.en_US
dc.description.urihttps://doi.org/10.1136/tsaco-2020-000662en_US
dc.language.isoen_USen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.ispartofTrauma Surgery and Acute Care Openen_US
dc.subjectCandidaen_US
dc.subjectfluconazoleen_US
dc.subjectinfectionsen_US
dc.subjectpostoperative complicationsen_US
dc.titleEmpiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulceren_US
dc.typeArticleen_US
dc.identifier.doi10.1136/tsaco-2020-000662
dc.source.volume6
dc.source.issue1


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