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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%)
 
  1. *Prospective randomized double-blind
  2. p < 0.05
  3. Not significant