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Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients

The role of empiric antifungals for post-surgical abscesses (PSAs) is controversial, and international guidelines on invasive mycoses focus on bloodstream infections. We analyzed a retrospective cohort of 319 patients with PSA at a tertiary-level hospital in Italy during the years 2013–2018. Factors...

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Autores principales: Taddei, Eleonora, Giovannenze, Francesca, Birocchi, Emanuela, Murri, Rita, Cerolini, Lucia, Segala, Francesco Vladimiro, Del Vecchio, Pierluigi, Taccari, Francesco, Fantoni, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10135368/
https://www.ncbi.nlm.nih.gov/pubmed/37107063
http://dx.doi.org/10.3390/antibiotics12040701
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author Taddei, Eleonora
Giovannenze, Francesca
Birocchi, Emanuela
Murri, Rita
Cerolini, Lucia
Segala, Francesco Vladimiro
Del Vecchio, Pierluigi
Taccari, Francesco
Fantoni, Massimo
author_facet Taddei, Eleonora
Giovannenze, Francesca
Birocchi, Emanuela
Murri, Rita
Cerolini, Lucia
Segala, Francesco Vladimiro
Del Vecchio, Pierluigi
Taccari, Francesco
Fantoni, Massimo
author_sort Taddei, Eleonora
collection PubMed
description The role of empiric antifungals for post-surgical abscesses (PSAs) is controversial, and international guidelines on invasive mycoses focus on bloodstream infections. We analyzed a retrospective cohort of 319 patients with PSA at a tertiary-level hospital in Italy during the years 2013–2018. Factors associated with empiric antifungal administration were analyzed and compared with factors associated with fungal isolation from the abdomen. Forty-six patients (14.4%) received empiric antifungals (65.2% azoles). Candida was isolated in 34/319 (10.7%) cases, always with bacteria. Only 11/46 patients receiving empirical antifungals had abdominal Candida. Only 11/34 patients with a fungal isolate received empiric antifungal therapy. Upper GI surgery (OR: 4.76 (CI: 1.95–11.65), p = 0.001), an intensive care unit stay in the previous 90 days (OR: 5.01 (CI: 1.63–15.33), p = 0.005), and reintervention within 30 days (OR: 2.52 (CI: 1.24–5.13), p = 0.011) were associated with empiric antifungals in a multivariate analysis, while pancreas/biliary tract surgery was associated with fungal isolation (OR: 2.25 (CI: 1.03–4.91), p = 0.042), and lower GI surgery was protective (OR: 0.30 (CI: 0.10–0.89), p = 0.029) in a univariate analysis. The criteria for empiric antifungal therapy in our practice seem to be inconsistent with the risk factors for actual fungal isolation. Better guidance for empiric therapy should be provided by wider studies.
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spelling pubmed-101353682023-04-28 Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients Taddei, Eleonora Giovannenze, Francesca Birocchi, Emanuela Murri, Rita Cerolini, Lucia Segala, Francesco Vladimiro Del Vecchio, Pierluigi Taccari, Francesco Fantoni, Massimo Antibiotics (Basel) Article The role of empiric antifungals for post-surgical abscesses (PSAs) is controversial, and international guidelines on invasive mycoses focus on bloodstream infections. We analyzed a retrospective cohort of 319 patients with PSA at a tertiary-level hospital in Italy during the years 2013–2018. Factors associated with empiric antifungal administration were analyzed and compared with factors associated with fungal isolation from the abdomen. Forty-six patients (14.4%) received empiric antifungals (65.2% azoles). Candida was isolated in 34/319 (10.7%) cases, always with bacteria. Only 11/46 patients receiving empirical antifungals had abdominal Candida. Only 11/34 patients with a fungal isolate received empiric antifungal therapy. Upper GI surgery (OR: 4.76 (CI: 1.95–11.65), p = 0.001), an intensive care unit stay in the previous 90 days (OR: 5.01 (CI: 1.63–15.33), p = 0.005), and reintervention within 30 days (OR: 2.52 (CI: 1.24–5.13), p = 0.011) were associated with empiric antifungals in a multivariate analysis, while pancreas/biliary tract surgery was associated with fungal isolation (OR: 2.25 (CI: 1.03–4.91), p = 0.042), and lower GI surgery was protective (OR: 0.30 (CI: 0.10–0.89), p = 0.029) in a univariate analysis. The criteria for empiric antifungal therapy in our practice seem to be inconsistent with the risk factors for actual fungal isolation. Better guidance for empiric therapy should be provided by wider studies. MDPI 2023-04-03 /pmc/articles/PMC10135368/ /pubmed/37107063 http://dx.doi.org/10.3390/antibiotics12040701 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Taddei, Eleonora
Giovannenze, Francesca
Birocchi, Emanuela
Murri, Rita
Cerolini, Lucia
Segala, Francesco Vladimiro
Del Vecchio, Pierluigi
Taccari, Francesco
Fantoni, Massimo
Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients
title Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients
title_full Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients
title_fullStr Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients
title_full_unstemmed Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients
title_short Empiric Antifungal Therapy for Intra-Abdominal Post-Surgical Abscesses in Non-ICU Patients
title_sort empiric antifungal therapy for intra-abdominal post-surgical abscesses in non-icu patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10135368/
https://www.ncbi.nlm.nih.gov/pubmed/37107063
http://dx.doi.org/10.3390/antibiotics12040701
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