Study | Criteria used for prophylaxis | Antifungal used for prophylaxis | Invasive candidiasis | Commentary |
---|---|---|---|---|
Positive prophylactic studies | ||||
*Slotman et al. 1987 [77] | Abdominal surgery + ≥ 3 risk factors | Ketoconazole 200 mg/d PO Placebo | 0/27 (0%) 5/30 (17%)†| Costs: $4,800 vs. $10,000†LOS: 6.0 vs. 12.5 days†|
*Savino et al. 1992 [78] | Surgical patients + hypermetabolism | Nystatin/norfloxacin PO Placebo | 6/25 (24%) 13/21 (62%)‡ | NI per patient: 0.9 vs. 2.0†|
Desai et al. 1992 [79] | Severely burned patients | Nystatin/polymyxin SDD No prophylaxis | 34/1042 (3.3%) 0/1439 (0%)†| Superficial infections: 59 (21%) vs. 22 (10%)†|
Eggimann et al. 1999 [39] * | Abdominal surgery + tertiary peritonitis | Fluconazole 400 mg/d IV Placebo | 1/23 (9%) 7/20 (35%)‡ | Candida peritonitis 1 (4%) vs. 7 (35%)†|
Pelz et al. 2001 [43] * | Surgical patients + LOS > 3 days | Fluconazole 400 mg/d PO Placebo | 11/130 (8%) 20/130 (15%)†| > 75% colonized at randomization |
Garbino et al. 2002 [42] * | Mechanically ventilated > 96 h | Fluconazole 100 mg PO + SDD Placebo + SDD | 4/103 (4%) 10/101 (10%)‡ | Candidemia: 9 vs. 1 (RR 0.1; CI 0.02-0.74)†|
Jacobs et al. 2003 [80] * | ICU + septic shock | Fluconazole 200 mg IV/d Placebo | 0/32 (0%) 1/39 (3%)‡ | Mortality significantly reduced in peritonitis |
He et al. 2003 [81] | Severe acute pancreatitis | Fluconazole 100 mg IV/d Placebo | 2/22 (9%)†7/23 (30%)†| Mortality 2/2 (100%) Mortality 3/7 (43%) |
Negative prophylactic studies | ||||
Savino et al. 1994 [78] | Surgical patients + LOS > 2 days | Nystatin 2 × 106 4 ×/d PO Ketoconazole 200 mg/d PO Clotrimazole 10 mg 3 ×/d PO No prophylaxis | 5/75 (7%) 1/65 (2%)‡ 1/80 (1%)‡ 2/72 (3%)‡ |  |
Ables et al. 2000 [82]* | Surgical patients + LOS > 2 days + other risk factors | Fluconazole 3 mg/kg 3 ×/w Placebo | 8/60 (13%) 11/59 (19%)‡ |  |
Sandven et al. 2002 [40]* | Surgery for peritonitis | Fluconazole 400 mg/d IV Placebo | - - | Mortality rates NS 4/53 (8%) vs. 8/56 (14%) |
Schuster et al. 2008 [83]* | ICU ≥ 4 d + Fever > 4 d under broad-spectrum antibiotics + APACHE II ≥ 16 | Fluconazole 400 mg/d IV Placebo | 6/122 (5%) 11/127 (9%)‡ |  |