Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized, Double-blind, Placebo Controlled Trial of Caspofungin Prophylaxis Followed by Pre-emptive Therapy for Invasive Candidiasis in High-risk Adults in the Critical Care Setting
Brief Summary: Adults admitted to intensive care units are at risk for a variety of complications. Infections due to the fungus called candida are of particular concern. The study will test the possibility that caspofungin, a new therapy for fungal infections, can successfully reduce the rate of candida infections in subjects at risk. It will also test if caspofungin is useful in treating subjects for this disease when diagnosed using a new blood test that is performed twice weekly, permitting earlier diagnosis than current practice standards.


Options:
A: Inclusion Criteria:

* Age ≥ 18 years
* Persistent sepsis without documented invasive candidiasis:

systemic inflammatory response syndrome (SIRS) presence of two signs on the 4 \[temperature \<36 ° C or\> 38 ° C, heart rate\> 90/min, respiratory rate\> 20/min or PaCO2 \<32 mmHg, leukocytosis\> 12,000 / mm3, \<4.000/mm3 or presence of circulating immature forms (\> 10% of cells)\] mechanical ventilation (intubation or tracheostomy) for over 4 days (96 hours) central line use of broad-spectrum antibacterial for more than 4 calendar days (96 hours) in the previous week presence of at least one extra-digestive site colonized by Candida sp. (Urine, mouth, throat, upper and lower respiratory tract, skin folds, and suction drains after surgery ...), not lower digestive tract, are not taken into account the positive samples of rectal swabs and / or stool cultures, absence of proven bacterial infections untreated no evidence of invasive fungal infections (positive blood culture, positive culture of a surgical site, deep biopsy with fungal) infection or mold according to the criteria of the group "fungal infection of the EORTC" organ failure

* Hospitalization in intensive care for over 5 days (120 hours)
* Giving a free, informed and in writing. In the absence of the person of trust or a family member (if present)consent to emergency possible.
* Receiving a social security system,
* Negative pregnancy test for patients of childbearing age

Exclusion Criteria:

* Proven invasive fungal infection (positive blood culture, positive culture of a surgical site, deep biopsy with fungal infection), including aspergillosis requiring antifungal therapy at the time of randomization
* Prognosis of less than 48 hours (for which the patient outcome will be fatal whatever treatment),
* Echinocandin antifungal treatment by more than one day or another antifungal for over 72 hours in the week before the inclusion visit,
* Allergy, hypersensitivity or known intolerance to echinocandins antifungal or any of the excipients of the drug
* Neutropenia (ANC \<500/mm3)
* History of organ and bone marrow,
* Recent chemotherapy (less than 6 months)
* Systemic immunosuppressive therapy in progress, other than with corticosteroids at doses below 2 mg / kg / day of prednisolone or equivalent
* Participation in another interventional study in the same ICU stay or making treatment being evaluated within 28 days prior to randomization
* Any clinical investigator deems incompatible with the conduct of the study in acceptable security conditions
* Pregnant and lactating women,
* Adults subject to a legal protection measure
* Persons deprived of their liberty by a judicial or administrative decision, those hospitalized without consent, persons admitted to a health facility or social purposes other than research
B: Inclusion Criteria:

* Non-pregnant \>18 yrs of age
* Subjects admitted to ICU during the preceding 3 days and expected to stay in the ICU for at least another 48 hours.Subjects can be enrolled on days 3-5 of ICU admission.
* Subjects meeting the clinical prediction rule

Exclusion Criteria:

* Subjects with an allergy/intolerance to caspofungin or echinocandin analog
* absolute neutrophil count \<500/mm3 at study entry or likely to develop such a count during therapy
* acquired immunodeficiency syndrome, aplastic anemia or chronic granulomatous disease
* moderate or severe hepatic insufficiency
* subjects who are pregnant or lactating
* unlikely to survive \< 24 hours
* subjects who have received systemic antifungal therapy within 10 days prior to study entry
* Documented active proven or probable invasive fungal infection upon enrollment
* previously enrolled in this study
* Currently on another investigational agent or have received an investigational agent within 10 days prior to study entry.
C: Inclusion Criteria:

* surgical patients admitted to our ICU older than 18 years of age and expected to require invasive mechanical ventilation for more than 48 h.

Exclusion Criteria:

* pregnancy,
* proven Candida infection,
* prophylactic or curative antifungal treatment within the last 2 months,
* contraindication to oral drug administration,
* known allergy to nystatin or its derivatives, and prior inclusion in the study
D: Inclusion Criteria:

* Age ≥18 years
* Admission to the intensive care unit for ≥ 72 hours and expected to stay an additional 48 hours
* IV access for administration of study drug
* Subject (or subject's legal representative) able to give written informed consent

Exclusion Criteria:

* History of hypersensitivity or intolerance to echinocandin antifungals
* Liver function test (ALT, AST (aspartate aminotransferase), and/or total bilirubin) greater than 10 times the upper limits of normal (ULN)
* Pregnant or lactating women
* Treatment with systemic antifungal therapy within the preceding 7 days
* Documented invasive fungal infection at baseline/screening
* Life expectancy less than 2 days or moribund

Answer: B