Incidence of candidemia before and after fluconazole prophylaxis implementation in a 14-bed general ICU

Introduction

Patients in ICUs account for the greatest number of candidemia in most hospitals. Fluconazole prophylaxis has been used to prevent candida infections in critically ill patients. In order to examine the effect of fluconazole prophylaxis implementation in our ICU we reviewed the records of all patients with blood cultures that grew Candida spp. (albicans and nonalbicans) 1 year before and after.

Methods

In 2006 we started using intravenous fluconazole administration as prophylaxis (400 mg/day) in selected patients (surgical, with central venous catheters, receiving broad-spectrum antibiotics, receiving TPN, requiring hemodialysis, spending more than 8 days in the ICU) as protocol. We recorded the incidence of candidemia for 2005 (4.03%) and 2006 (1.7%) as well. We also recorded the candidemic patient's age (mean, 47.84 years/51 years), sex (10 men, three women/four men, one woman), APACHE II score on admission (mean, 11.27/12), days spent in ICU (46 ± 30.30 days/98 ± 68.44 days), median day of candida isolation (17th day (2nd–50th day)/46th day (23rd–208th day)), whether they were receiving TPN (30.8%/60%), and outcome. All candidemic patients were treated with liposomic amphotericin.

Results

In 2005, 322 patients were admitted to our ICU – 13 of them had at least one blood culture that yielded Candida (six C. albicans, seven Candida spp). None of them received fluconazole prophylaxis. Seven patients (53.8%) died. In 2006, 291 patients were admitted – five of them developed candidemia (two C. albicans, three C. parapsilosis), four were under prophylaxis and three of them developed C. parapsilosis. Three patients (60%) died.

Conclusion

Although the number of patients is small, it seems that fluconazole prophylaxis can prevent candidemia in critically ill patients, but also may promote the development of nonalbicans species, which are resistant to fluconazole.