Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients

作者：Philippe Eggimann, Patrick B. Francioli, Jacques Billé, Remy Schneider, Mei-Miau Wu, Germain Chapuis, René L. Chioléro, André Pannatier, Julian Schilling, Stefanos Geroulanos, Michel Pierre Glauser, Thierry Calandra · 发表于：Critical Care Medicine · 年份：1999 · DOI：10.1097/00003246-199906000-00019 · 被引用次数：416 · 研究领域：Antifungal resistance and susceptibility、Surgical site infection prevention、Nosocomial Infections in ICU

OBJECTIVE: To evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGN: Randomized, prospective, double-blind, placebo-controlled study. SETTING: Two university-affiliated hospitals in Switzerland. PATIENTS: Forty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONS: Prophylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated daily, and specimens for culture were obtained three times per week during prophylaxis. The primary study end points were the frequency of and the time to intra-abdominal Candida infections. Secondary end points were the frequency of candidiasis (intra-abdominal and extra-abdominal) and the emergence or persistence of Candida colonization. Among patients who were not colonized at study entry, Candida was isolated from surveillance cultures during prophylaxis in 15% of the patients in the fluconazole group and in 62% of the patients in the placebo group (relative risk, 0.25; 95% confidence interval, 0.07 to 0.96; p = .04). Candida peritonitis occurred in one of 23 patients (4%) who received fluconazole and in seven of 20 patients (35%) who received placebo (relative risk, 0.12; 95% confidence interval, 0.02 to 0.93; p = .02). In addition, one catheter-related Candida albicans se...