by Djamel Mokart,
Mehdi Boutaba, Luca Servan, Benjamin Bertrand, Olivier Baldesi, Laurent
Lefebvre, Frédéric Gonzalez, Magali Bisbal, Bruno Pastene, Gary Duclos, Marion
Faucher, Laurent Zieleskiewicz, Laurent Chow-Chine, Antoine Sannini, Jean Marie
Boher, Romain Ronflé…
Annals of
Intensive Care volume 14, Article number: 98, Published: 25
June 2024
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.
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