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

Détails

ID Serval
serval:BIB_72782E55BABA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients.
Périodique
Critical care medicine
Auteur(s)
Eggimann P., Francioli P., Bille J., Schneider R., Wu M.M., Chapuis G., Chiolero R., Pannatier A., Schilling J., Geroulanos S., Glauser M.P., Calandra T.
ISSN
0090-3493
Statut éditorial
Publié
Date de publication
1999
Peer-reviewed
Oui
Volume
27
Numéro
6
Pages
1066-72
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't - Publication Status: ppublish
Résumé
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 sepsis occurred in a fluconazole-treated patient. Thus, overall, candidiasis developed in two fluconazole patients and seven placebo patients (relative risk, 0.25; 95% confidence interval, 0.06 to 1.06; p = .06). C. albicans accounted for 87% of the Candida species isolated before or during prophylaxis, and all C. albicans strains were susceptible to fluconazole. Fluconazole was well tolerated, and adverse events occurred at similar frequencies in both treatment groups. CONCLUSIONS: Fluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients.
Mots-clé
Abdomen, Adult, Aged, Aged, 80 and over, Antifungal Agents, Candida, Candidiasis, Critical Care, Double-Blind Method, Equipment Contamination, Female, Fluconazole, Humans, Infusions, Intravenous, Male, Middle Aged, Peritonitis, Postoperative Complications, Prospective Studies, Risk Factors
Pubmed
Web of science
Création de la notice
25/01/2008 10:58
Dernière modification de la notice
03/03/2018 18:17
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