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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