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Abstract

Background:

An evidence gap exists in anti-fungal diagnostic practice following abdominal surgery, especially when compared to haem-oncology counterparts. In light of the recent Anti-fungal Stewardship CQUIN, our study addresses the utility of serum (1,3)-β-D-Glucan (BDG) testing post-gastrointestinal surgery.

Method:

We identified positive BDG results (>/=80pg/mL) on ITU and surgical wards in 3 major institutions in the Bristol area. Those with a ‘history of abdominal surgery </=30 days previous’ were identified using electronic health records. Other variables included number of days from surgery to testing, value of the result, and past medical history.

Results:

110 patients with positive results were identified. 19 (17.3%) of these had a history of abdominal surgery. By surgical type, 6 (31.6%) had major abdominal surgery. 6 (31.6%) had pancreatic surgery and 5 (26.3%) small bowel resection. 2 had other types of surgery. The mean BDG score was 286pg/mL. 1 patient had risk factors other than gastrointestinal surgery for a positive BDG result.

Only 1 patient died within 28 days. Patients tested between 0-9, 10-19 or 20-30 days of surgery had mean BDG scores of 329pg/mL, 302pg/mL and 390pg/mL respectively. 40% were tested within 9 days of surgery. There was no clear evidence of invasive fungal infections.

Conclusion:

Positive BDG testing is common after surgery, but does not appear to be associated with a significant mortality burden. Ensuring appropriate anti-fungal therapy is essential for treatment, risk reduction and cost containment. More research is needed to identify appropriate testing strategies in patients with abdominal surgery.

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/content/journal/acmi/10.1099/acmi.fis2019.po0107
2020-02-28
2020-06-02
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http://instance.metastore.ingenta.com/content/journal/acmi/10.1099/acmi.fis2019.po0107
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