Fluconazole prophylaxis of systemic candida infection in non-neutropenic critically ill patients: a prospective randomized study

Introduction

Systemic Candida infection has been associated with increased morbidity and mortality in patients requiring intensive care. Fluconazole (F) is the preferred therapy in Candida albicans infection. The aim of the study was to evaluate effect of daily prophylactic fluconazole administration on the incidence of systemic Candida infection.

Methods

After institutional approval 38 critically ill patients were prospectively studied. In 18 patients (group F) presumptive fluconazole therapy after admission was started in daily dose 100 mg intravenously until discharge or evidence of systemic candida infection, which was treated using standard dosage. Control group (C) consisted of 20 patients. Apache II, candida colonization, selected risk factors for candidemia (central venous and urinary catheters, parenteral nutrition, corticosteroids therapy, broad-spectrum antibiotics, H₂-receptor antagonists), length of ICU and hospital stay, ventilatory days, incidence of candida albicans and non albicans candida species were recorded. The cultures from nasopharynx, trachea, urine, stool and blood stream were taken. Values are expressed as a mean (SD), t-test, Mann Whitney Rank Sum test, z-test were used for statistical analysis, P < 0.05 was considered significant.

Results

Selected results are presented in the Table.

Conclusion

There were no significant differences in incidence of candida colonization and proportion of albicans v. non albicans species between both groups. Hospital and ICU stay and length of ventilatory support were nonsignificantly longer in group F. Clinical usefulness of early fluconazole prophylaxis needs to be further evaluated.

Table abstract