{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:18:29Z","timestamp":1788261509384,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>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 \u00b1 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\u201319 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 &lt; 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.<\/jats:p>","DOI":"10.3390\/antibiotics15090842","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:32:18Z","timestamp":1788258738000},"page":"842","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fungal Identification and Empirical Antifungal Treatment in Critically Ill Patients with Secondary Peritonitis\u2014A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-8994","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Bernardo","sequence":"first","affiliation":[{"name":"Cl\u00ednica Universit\u00e1ria de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7468-9141","authenticated-orcid":false,"given":"Susana M.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universit\u00e1ria de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"},{"name":"Servi\u00e7o de Medicina Intensiva, Unidade Local de Sa\u00fade de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana S.","family":"Nepomuceno","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universit\u00e1ria de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Pinto","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Intensiva, Unidade Local de Sa\u00fade de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7207-8948","authenticated-orcid":false,"given":"Jo\u00e3o M.","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Intensiva, Unidade Local de Sa\u00fade de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Intensiva, Unidade Local de Sa\u00fade de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1007\/s00134-002-1498-9","article-title":"Surgical re-intervention in postoperative peritonitis based on longitudinal scoring systems","volume":"28","author":"Lamme","year":"2002","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1001\/jama.298.8.865","article-title":"Dutch Peritonitis Study Group. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: A randomized trial","volume":"298","author":"Mahler","year":"2007","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/01.CCM.0000053525.49267.77","article-title":"Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis?","volume":"31","author":"Dupont","year":"2003","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1001\/archsurg.1993.01420140070011","article-title":"Surgical Infection Society intra-abdominal infection study: Prospective evaluation of management techniques and outcome","volume":"128","author":"Christou","year":"1993","journal-title":"Arch. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1001\/archsurg.1996.01430140070019","article-title":"Prognosis and treatment of peritonitis. Do we need new scoring systems?","volume":"131","author":"Koperna","year":"1996","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/00000658-199607000-00003","article-title":"Management of secondary peritonitis","volume":"224","author":"Wittmann","year":"1996","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1002\/bjs.4517","article-title":"Mortality and morbidity of planned relaparotomy versus relaparotomy on demand for secondary peritonitis","volume":"91","author":"Lamme","year":"2004","journal-title":"Br. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1749-7922-5-9","article-title":"A focus on intraabdominal infections","volume":"5","author":"Sartelli","year":"2010","journal-title":"World J. Emerg. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1007\/s00134-013-3109-3","article-title":"A research agenda on the management of intra-abdominal candidiasis: Results from a consensos of multinational experts","volume":"39","author":"Bassetti","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1164\/rccm.201211-2069OC","article-title":"Fungal Infection Network of Switzerland (FUNGINOS). \u00df-glucan antigenemia anticipates diagnosis of blood culture-negative intraabdominal candidiasis","volume":"188","author":"Tissot","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1001\/archsurg.137.12.1341","article-title":"Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients","volume":"137","author":"Dupont","year":"2002","journal-title":"Arch. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1097\/00003246-200203000-00008","article-title":"Significance of Candida recovered from intraoperative specimens in patients with intraabdominal perforations","volume":"30","author":"Sandven","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1097\/01.CCM.0000201889.39443.D2","article-title":"Candida as a risk factor for mortality in peritonitis","volume":"34","author":"Montravers","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/2110-5820-1-37","article-title":"Diagnosis of invasive candidiasis in the ICU","volume":"1","author":"Eggimann","year":"2011","journal-title":"Ann. Intensive Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s13054-016-1313-6","article-title":"Diagnosis and management of invasive candidiasis in the ICU: An updated approach to an old enemy","volume":"20","author":"Calandra","year":"2016","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1097\/00003246-199906000-00019","article-title":"Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients","volume":"27","author":"Eggimann","year":"1999","journal-title":"Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s00268-005-7807-z","article-title":"Early presumptive therapy with fluconazole for occult Candida infection after gastrointestinal surgery","volume":"30","author":"Shan","year":"2006","journal-title":"World J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Aguilar, G., Delgado, C., Corrales, I., Izquierdo, A., Gracia, E., Moreno, T., Romero, E., Ferrando, C., Carbonell, J.A., and Borr\u00e1s, R. (2015). Epidemiology of invasive candidiasis in a surgical intensive care unit: An observational study. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1458-4"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","article-title":"Global guideline for the diagnosis and management of candidiasis: An initiative of the ECMM in cooperation with ISHAM and ASM","volume":"25","author":"Cornely","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1086\/378702","article-title":"Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections","volume":"37","author":"Solomkin","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1086\/380796","article-title":"Guidelines for treatment of candidiasis","volume":"38","author":"Pappas","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Koca, F., Sliwinski, S., Uttinger, K., Petrova, E., Malkomes, P., Hogardt, M., Kempf, V.A.J., Benk\u00f6, T., Wiegering, A., and Matthes, N. (2026). Detection of Candida spp. Froma peritoneal swabs indicate worse outcome in patients with perforated peptic ulcer: Revisiting a longstanding debate. BMC Surg., 26.","DOI":"10.1186\/s12893-026-03518-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s40121-021-00585-6","article-title":"The Study Group for Infections in Critically Ill Patients (ESGCIP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study","volume":"11","author":"Bassetti","year":"2022","journal-title":"Infect. Dis. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1089\/sur.2023.333","article-title":"Risk Factors for Invasive Candidiasis in Critically Ill Patients Who Underwent Emergency Gastrointestinal Surgery for Complicated Intra-Abdominal Infection","volume":"25","author":"Park","year":"2024","journal-title":"Surg. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1089\/sur.2023.149","article-title":"Identification of Risk Factors for Intra-Abdominal Candidiasis","volume":"24","author":"Habighorst","year":"2023","journal-title":"Surg. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Tahtler, J.G., Cicvari\u0107, A., Koulenti, D., Karvouniaris, M., Bogdan, M., Kralik, K., Kmoni\u010dek, I.K., Mlinarevi\u0107, M.G., and Kvolik, S. (2024). Isolation of Candida Species Is Associated with Comorbidities, Prolonged Mechanical Ventilation, and Treatment Outcomes in Surgical ICU Patients, a Cross-Sectional Study. J. Fungi, 10.","DOI":"10.3390\/jof10110743"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1007\/s00134-022-06883-y","article-title":"Abdominal Sepsis Study (AbSeS) group and the Trials Group of the European Society of Intensive Care Medicine. Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis","volume":"48","author":"Antonelli","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e0117824","DOI":"10.1128\/aac.01178-24","article-title":"Antibacterial and antifungal drug concentrations in intra-abdominal abscesses: A prospective clinical study","volume":"69","author":"Costa","year":"2025","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00134-015-3866-2","article-title":"A multicenter multinational study of abdominal candidiasis: Epidemiology, outcomes and predictors of mortality","volume":"41","author":"Bassetti","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0974-2700.130883","article-title":"An introduction of Tertiary Peritonitis","volume":"7","author":"Mishra","year":"2014","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1093\/cid\/ciae346","article-title":"2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation in Adults, Children, and Pregnant People","volume":"79","author":"Bonomo","year":"2024","journal-title":"Clin. 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