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
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.
Authors
- Andrea Gochi (ORCID: https://orcid.org/0000-0002-2917-451X)
- Nathan J. Alcasid (ORCID: https://orcid.org/0000-0002-0016-8474)
- Seema P. Anandalwar (ORCID: https://orcid.org/0009-0005-2651-0695)
- Alexander J. Ordoobadi (ORCID: https://orcid.org/0000-0002-2507-6373)
- Amber Himmler (ORCID: https://orcid.org/0000-0001-7180-5787)
- Brendin R. Beaulieu‐Jones (ORCID: https://orcid.org/0000-0002-1208-8025)
- Christopher A. Guidry (ORCID: https://orcid.org/0000-0003-0749-8625)
- Pedro G. Teixeira (ORCID: https://orcid.org/0000-0002-7258-7977)
- A. Caballero Mendoza
- C. Galet
- Sabrina Elena Sanchez (ORCID: https://orcid.org/0000-0003-2437-9505)
- Geoffrey A. Anderson (ORCID: https://orcid.org/0000-0001-5756-995X)
- Cynthia J. Susai (ORCID: https://orcid.org/0000-0003-1787-0806)
- Vahe S Panossian (ORCID: https://orcid.org/0000-0001-8085-1021)
- J. Rickard
- Jonathan Gipson
- Michael P. DeWane (ORCID: https://orcid.org/0000-0002-7042-7400)
- Sarah E McWilliam
- Yasmin Arda
- Nicole Nitschke
- Lillian A. Nefcy
- David P. Blake
- Wardah Rafaqat
- Patrick McGonagill
- Brianna L. Collie
- Dias Argandykov
- Erik J. Teicher
- Joseph Cuschieri
- Jonathan Meizoso
- Mira Ghneim
- Jeffrey L. Johnson
Institutions
- University of Maryland, Baltimore (US)
- Brigham and Women's Hospital (US)
- Boston Medical Center (US)
- University of Minnesota (US)
- University of California, San Francisco (US)
- Inova Fairfax Hospital (US)
- University of Iowa Hospitals and Clinics (US)
- Henry Ford Hospital (US)
- Massachusetts General Hospital (US)
- Penn Center for AIDS Research (US)
- University of Kansas Medical Center (US)
- University of Iowa Health Care (US)
- University of Pennsylvania Health System (US)
Publication Details
- Journal
- Surgical Infections
- Published
- 2026-01-09
- DOI
- https://doi.org/10.1177/10962964251412214
- Primary Topic
- Surgical site infection prevention
- Type
- article
- Field-Weighted Citation Impact
- 0.00