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Critical Care Research and Practice
Volume 2014, Article ID 479413, 8 pages
http://dx.doi.org/10.1155/2014/479413
Clinical Study

An Observational Study on Early Empiric versus Culture-Directed Antifungal Therapy in Critically Ill with Intra-Abdominal Sepsis

1Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608
2Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608
3Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 169608

Received 6 February 2014; Accepted 17 April 2014; Published 15 May 2014

Academic Editor: Djillali Annane

Copyright © 2014 Winnie Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To compare early empiric antifungal treatment with culture-directed treatment in critically ill patients with intra-abdominal sepsis. Methods. A prospective observational cohort study was conducted between August 2010 and July 2011, on SICU patients admitted after surgery for gastrointestinal perforation, bowel obstruction or ischemia, malignancy and anastomotic leakages. Patients who received antifungal treatment within two days of sepsis onset were compared to patients who received culture-directed antifungal treatment in terms of mortality rate and clinical improvement. Patients’ demographics, comorbidities, severity-of-illness scores, and laboratory results were systematically collected and analysed. Results. Thirty-three patients received early empiric and 19 received culture-directed therapy. Of these, 30 from the early empiric group and 18 from culture-directed group were evaluable and analysed. Both groups had similar baseline characteristics and illness severity. Patients on empiric antifungal use had significantly lower 30-day mortality ( ) as well as shorter median time to clinical improvement ( ). Early empiric antifungal therapy was independently associated with survival beyond 30 days (OR 0.131, 95% CI: 0.018 to 0.966; ). Conclusion. Early empiric antifungal therapy in surgical patients with intra-abdominal sepsis was associated with reduced mortality and warrants further evaluation in randomised controlled trials.