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%)‡ |