Fungal Identification and Empirical Antifungal Treatment in Critically Ill Patients with Secondary Peritonitis—A Retrospective Cohort Study

Abstract

Background/Objectives: The clinical impact of empirical antifungal therapy in patients with secondary peritonitis and sepsis remains incompletely established. This study aimed to identify risk factors for fungal infection in this population and the impact of empirical antifungal therapy on clinical outcomes. Methods: This was a retrospective cohort study of critically ill patients who underwent abdominal surgery for visceral lesions. Demographic and microbiological data were extracted from electronic health records. Results: A total of 411 patients, 56.9% male and with an average age of 68.8 ± 15.8 years, admitted following urgent gastrointestinal surgery were included. Fungi were isolated from peritoneal fluid or blood in 13.9% of patients during their ICU stay, with a median hospital length of stay until identification of 10 days (interquartile range 1–19 days). Candida albicans was isolated in 63.2% of the positive samples. Empirical antifungal was provided in 27.3% (n = 112). Each additional surgical procedure (OR: 1.47; p < 0.001) was the only risk factor identified for fungal infection in multivariate logistic regression. ICU mortality among patients with and without fungal documentation was similar, as was ICU mortality among patients with and without empirical antifungal therapy. Conclusions: The mortality impact of fungal isolation remains uncertain. Our results suggest that routine empirical antifungal therapy should be approached with caution, prioritizing targeted therapy for patients with confirmed positive cultures or a persistent, refractory clinical course despite adequate source control. These findings should be interpreted as hypothesis-generating and warrant confirmation in future prospective studies before informing changes in clinical practice.