Empirical antifungal therapy for health care-associated intra-abdominal infection: a retrospective, multicentre and comparative study

Abstract

Background: Current guidelines recommend using antifungals for selected patients with health care-associated intra-abdominal infection (HC-IAI), but this recommendation is based on a weak evidence. This study aimed to assess the association between early empirical use of antifungals and outcomes in intensive care unit (ICU) adult patients requiring re-intervention after abdominal surgery.

Methods: A retrospective, multicentre cohort study with overlap propensity score weighting was conducted in three ICUs located in three medical institutions in France. Patients treated with early empirical antifungals for HC-IAI after abdominal surgery were compared with controls who did not receive such antifungals. The primary endpoint was the death rate at 90 days, and the secondary endpoints were the death rate at 1 year and composite criteria evaluated at 30 days following the HC-IAI diagnosis, including the need for re-intervention, inappropriate antimicrobial therapy and death, whichever occurred first.

Results: At 90 days, the death rate was significantly decreased in the patients treated with empirical antifungals compared with the control group (11.4% and 20.7%, respectively, p = 0.02). No differences were reported for the secondary outcomes.

Conclusion: The use of early empirical antifungal therapy was associated with a decreased death rate at 90 days, with no effect on the death rate at 1 year, the death rate at 30 days, the rate of re-intervention, the need for drainage, and empirical antibiotic and antifungal therapy failure at 30 days.

Keywords: Candidiasis; Death rate; Empirical antifungal therapy; Health care-associated intra-abdominal infection; Intensive care.

Fig. 1

Flowchart of inclusion

Fig. 2

Probability of survival according to empirical antifungal therapy use (naïve and weighted analysis) (a), cumulative incidence of the composite criteria occurrence according to empirical antifungal therapy use (naïve and weighted analysis) (b). EAF group, empirical antifungal therapy group

Fig.3

Dendrogram showing the unsupervised ascendant hierarchical cluster analysis forming 3 clusters (a), scatterplot showing the 271 patients’ distribution in the 3 clusters in the two first dimensions obtained from the factor analysis of mixed data (FAMD) model (b), probability of survival according to empirical antifungal therapy use in the Cluster 2