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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