Role of Antifungals in Gastrointestinal Perforations due to Penetrating Trauma: A Sub-group Analysis of the FUNGUS Multicenter Trial

Authors:
Alexander Ordoobadi, Andrea Gochi, Brendin Beaulieu-Jones, Chris Guidry, Cynthia Susai, David Blake, Erik Teicher, Geoffrey Anderson, Nathan Alcasid, Sabrina Sanchez, MD, Seema Anandalwar, SIS FUNGUS Multicenter Study Participants, Vahe S Panossian, Wardah Rafaqat

Body of Abstract:
Introduction: The role of prophylactic antifungal use in the setting of penetrating traumatic gastrointestinal injuries (GI) remains unclear. The aim of this study is to assess the association of antifungal use and organ space infections in penetrating traumatic GI injuries. We hypothesize that prophylactic antifungals would provide no clinical benefit.
Methods: This was a subgroup analysis of a multicenter prospective cohort study conducted across 17 centers between August 21 and January 2024. The inclusion criterion was patients ( 18 years of age) requiring operative management of a penetrating GI injury. Those who required antifungal therapy for other reasons or had positive fungal cultures at the time of surgery were excluded. The primary outcome was organ-space infections (OSI). A multivariable logistic regression model was used to identify OSI.
Results: Of the 173 patients presenting with GI perforations due to penetrating trauma, 40 (23.12%) received prophylactic antifungal therapy. The median age was 34 years, 13.3% were female, 1.16% had an esophageal injury, 38.15% had a gastric injury, and 60.69% had a bowel injury. Overall, 20 (11.56%) developed OSI. On univariable analysis, OSI was not significantly different between patients who received prophylactic antifungal therapy and those who did not (17.5% vs 9.77%, p=0.18). On regression analysis, antifungal use was not significantly associated with OSI (OR 2.10, 95% CI 0.70-6.32, p=0.185) (Table 1).
Conclusions: The empirical use of antifungals in patients with gastrointestinal perforations due to penetrating trauma is not significantly associated with a decrease in intra-abdominal organ space infections.