Re-Evaluating the Necessity of Empiric Anti-Fungal Coverage in Gastroduodenal Perforations

Abstract

Objectives

Research has suggested empiric perioperative antifungal coverage in gastroduodenal perforations does not reduce the risk of mortality and results in unnecessary exposure to antifungals. Identifying patients at highest risk for fungal infection who could benefit from tailored empiric fungal coverage is important. This study aimed to identify risk factors for fungal infection after gastroduodenal perforation (GDP). Empiric antifungal coverage may prove beneficial in mortality, length of stay (LOS), and need for reoperation for patients with GDP.

Methods

A retrospective cohort study was conducted of adult patients from 2018 to 2024. Adult patients with nontraumatic CPT codes 43631, 43632, 43840, and 43659, with complete electronic medical records were included.

Results

151 patients met inclusion criteria, with 19 (12.6%) developing a culture-proven fungal infection during admission. Patients with fungal infections were admitted in worse clinical condition, with higher rates of vasopressor use (47.4% vs 22.7%, P = 0.044) and anemia (hemoglobin 10.6 g/dL vs 13.5 g/dL, P = 0.002). These patients had a longer LOS (23 days vs 12 days, P = 0.003), and required more surgeries (2.53 ± 2.01 vs 1.52 ± 1.43, P = 0.048). There was no significant difference in in-hospital mortality. Empiric antifungal agents were administered to 78.9% of patients who developed a confirmed fungal infection and 44.7% of patients who did not develop a fungal infection (P = 0.011).

Conclusion

Patients with nontraumatic GDP and a fungal infection were more likely to require vasopressors and be anemic on admission, although a significant mortality difference was not detected. Given the rate of non-albicans species isolated, the most appropriate empiric agent needs to be investigated.