Diagnosis of invasive candidiasis in the ICU

Philippe Eggimann; Jacques Bille; Oscar Marchetti

doi:10.1186/2110-5820-1-37

Annals of Intensive Care

Table 3 Criteria used for antifungal prophylaxis in adult critically ill patients

From: Diagnosis of invasive candidiasis in the ICU

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%)^‡

*Prospective randomized double-blind
^†p < 0.05
^‡Not significant

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