OBJECTIVE: Infections caused by Candida spp. are a major cause of morbidity and mortality in critically ill patients and usually develop from endogenous colonization. We assessed the effectiveness of adding fluconazole to a selective digestive decontamination regimen to prevent candidal infections. DESIGN AND SETTING: We performed a prospective, randomized, double-blind, placebo-controlled trial among medical and surgical intensive care unit patients at a large university hospital. PATIENTS: All adult patients mechanically ventilated for at least 48 h with an expectation to remain so for at least an additional 72 h, and receiving selective decontamination of the digestive tract. INTERVENTIONS: Patients were randomly assigned fluconazole 100 mg daily (n=103) or placebo (n=101). MEASUREMENTS AND RESULTS:Candida infections occurred less frequently in the fluconazole group (5.8%) than in the placebo group (16%; rate ratio 0.35; Cl(95) 0.11-0.94). Some 90% of candidemia episodes occurred in the placebo group (rate ratio for fluconazole use 0.10; Cl(95) 0.02-0.74). The rate of treatment failure, development of candidal infection, or increased colonization, was 32% in the fluconazole group and 67% in the placebo group (P<0.001). Crude in-hospital mortality was similar in the two groups (39% fluconazole vs. 41% placebo). CONCLUSIONS: Prophylactic use of fluconazole in a selected group of mechanically ventilated patients at high risk for infection reduces the incidence of Candida infections, in particular candidemia.
RCT Entities:
OBJECTIVE: Infections caused by Candida spp. are a major cause of morbidity and mortality in critically illpatients and usually develop from endogenous colonization. We assessed the effectiveness of adding fluconazole to a selective digestive decontamination regimen to prevent candidal infections. DESIGN AND SETTING: We performed a prospective, randomized, double-blind, placebo-controlled trial among medical and surgical intensive care unit patients at a large university hospital. PATIENTS: All adult patients mechanically ventilated for at least 48 h with an expectation to remain so for at least an additional 72 h, and receiving selective decontamination of the digestive tract. INTERVENTIONS:Patients were randomly assigned fluconazole 100 mg daily (n=103) or placebo (n=101). MEASUREMENTS AND RESULTS:Candida infections occurred less frequently in the fluconazole group (5.8%) than in the placebo group (16%; rate ratio 0.35; Cl(95) 0.11-0.94). Some 90% of candidemia episodes occurred in the placebo group (rate ratio for fluconazole use 0.10; Cl(95) 0.02-0.74). The rate of treatment failure, development of candidal infection, or increased colonization, was 32% in the fluconazole group and 67% in the placebo group (P<0.001). Crude in-hospital mortality was similar in the two groups (39% fluconazole vs. 41% placebo). CONCLUSIONS: Prophylactic use of fluconazole in a selected group of mechanically ventilated patients at high risk for infection reduces the incidence of Candida infections, in particular candidemia.
Authors: H K F Van Saene; L Silvestri; A Petros; M Viviani; M A de la Cal; D F Zandstra Journal: Intensive Care Med Date: 2003-05-16 Impact factor: 17.440
Authors: J M Boonstra; A G Märtson; I Sandaradura; J G W Kosterink; T S van der Werf; D J E Marriott; J G Zijlstra; D J Touw; J W C Alffenaar Journal: Antimicrob Agents Chemother Date: 2021-02-17 Impact factor: 5.191
Authors: Pierre Emmanuel Charles; Frédéric Dalle; Hervé Aube; Jean Marc Doise; Jean Pierre Quenot; Ludwig Serge Aho; Pascal Chavanet; Bernard Blettery Journal: Intensive Care Med Date: 2005-02-12 Impact factor: 17.440
Authors: Laurence Senn; Philippe Eggimann; Riadh Ksontini; Andres Pascual; Nicolas Demartines; Jacques Bille; Thierry Calandra; Oscar Marchetti Journal: Intensive Care Med Date: 2009-01-27 Impact factor: 17.440