Journal article
Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation
Surgical infections, Vol.26(8), pp.618-626
10/2025
DOI: 10.1089/sur.2024.306
PMID: 40358474
Abstract
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.
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.
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).
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.
Details
- Title: Subtitle
- Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation
- Creators
- Andrea M Gochi - University of California, San FranciscoWardah Rafaqat - Massachusetts General HospitalVahe Panossian - Massachusetts General HospitalMira Ghneim - Program in Trauma, University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USASeema Anandalwar - Program in Trauma, University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USADias Argandykov - Massachusetts General HospitalCynthia J Susai - University of California, San FranciscoNathan J Alcasid - University of California, San FranciscoGeoffrey A Anderson - Brigham and Women's HospitalAlexander J Ordoobadi - Brigham and Women's HospitalErik J Teicher - Inova Health SystemDavid P Blake - Inova Health SystemBrendin R Beaulieu-Jones - Boston Medical CenterSabrina E Sanchez - Boston Medical CenterChristopher A Guidry - University of Kansas Medical CenterPedro Teixeira - The University of Texas at AustinJonathan Meizoso - University of MiamiBrianna L Collie - University of MiamiSarah McWilliam - The University of Texas at AustinPatrick McGonagill - University of IowaNicole Nitschke - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USATara Kortlever - University of IowaColette Galet - University of IowaLillian A Nefcy - Henry Ford Health SystemJeffrey L Johnson - Henry Ford Health SystemMichael P DeWane - Massachusetts General HospitalJoseph Cuschieri - University of California, San FranciscoAmber Himmler - Emory UniversityJennifer Rickard - University of MinnesotaJonathan Gipson - University of MinnesotaApril E Mendoza - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- Surgical infections, Vol.26(8), pp.618-626
- DOI
- 10.1089/sur.2024.306
- PMID
- 40358474
- NLM abbreviation
- Surg Infect (Larchmt)
- ISSN
- 1096-2964
- eISSN
- 1557-8674
- Publisher
- Mary Ann Liebert
- Language
- English
- Electronic publication date
- 05/13/2025
- Date published
- 10/2025
- Academic Unit
- Surgery
- Record Identifier
- 9984822957902771
Metrics
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