375: ANTIFUNGAL USE IN CRITICALLY ILL PATIENTS WITH INTRA-ABDOMINAL INFECTION

Abstract

Introduction: Intra-abdominal infections arise from microorganisms which translocate from their normal location and result in peritoneal inflammation. Initiation of antifungal treatment for complicated intra-abdominal infections has limited clinical evidence and remains unclear. In 2010, the IDSA and SIS released a joint guideline regarding diagnosis and management of complicated intra-abdominal infections (IAIs). However in the following years, the two entities released their own individual guidelines. The goal of this study is to further delineate if there is a potential benefit for use of empiric antifungal therapy in critically ill patients with an IAI. Methods: This is a retrospective chart review study that screened hospitalized adult patients admitted to the intensive care units (ICU) with proven or suspected intra-abdominal infection and associated ICD-10 code between January 2020 to December 2021. Medical charts were reviewed for relevant demographic, clinical, and laboratory data. The primary endpoint is hospital length of stay (LOS). Secondary outcomes include ICU LOS, source of infection, surgical intervention, and mortality. A sub-group analysis comparing azole and echinocandin treatment was conducted; endpoints include hospital LOS, ICU LOS, source of infection, surgical intervention, antifungal duration, mortality, and rate of discharge on antifungal therapy. Results: From January 2020 – December 2021, 1086 patients were screened for eligibility and 166 patients were enrolled. The sample size was primarily male (53.4%) and Hispanic (36.1%) or Asian (28.9%). In this study, statistical significance was found for LOS (p< 0.0001), ICU LOS (p< 0.0001), surgical intervention (p< 0.0001) and peritoneum as source of infection (p=0.0006). In the sub-group analysis, statistical significance was found with surgical intervention (p< 0.0001), hospital LOS (p< 0.0001) and ICU LOS (p< 0.0001) in the micafungin treatment arm. Conclusions: In this study, use of antifungal treatment in critically ill patients decreased hospital LOS, ICU LOS, and surgical intervention. Patients on antifungal treatment may have had a higher severity of IAIs. There is an ongoing need for better characterization of patients at risk for poor prognosis.