The Answer Is In: Fluconazole Prophylaxis Is Not Beneficial for Intensive Care Unit Patients without Neutropenia
Authors: Thomas Fekete
Journal: Annals of Internal Medicine (2008)

Editorials15 July 2008The Answer Is In: Fluconazole Prophylaxis Is Not Beneficial for Intensive Care Unit Patients without NeutropeniaThomas Fekete, MDThomas Fekete, MDFrom Temple University School of Medicine, Philadelphia, PA 19140.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-2-200807150-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The prevention of hospital infections in high-risk environments, such as intensive care units (ICUs), is a major goal of the patient safety movement. Fungal infections in the ICU—particularly candidemia—are especially troubling because they disproportionately affect the highest-risk patients and therefore inflict major morbidity and mortality. Although preventing these infections is a worthy goal, the specific strategy of using chemoprophylaxis has remained controversial, because we have an incomplete understanding of the risks, benefits, and costs of this approach, despite the availability of well-tolerated systemic antifungal drugs, such as fluconazole (1). The absence of conclusive evidence invites clinicians to make their own ...References1. Rex JH, Sobel JD. Prophylactic antifungal therapy in the intensive care unit. Clin Infect Dis. 2001;32:1191-200. [PMID: 11283809] CrossrefMedlineGoogle Scholar2. Pelz RK, Hendrix CW, Swoboda SM, Diener-West M, Merz WG, Hammond J, et al. Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg. 2001;233:542-8. [PMID: 11303137] CrossrefMedlineGoogle Scholar3. Shorr AF, Chung K, Jackson WL, Waterman PE, Kollef MH. Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis. Crit Care Med. 2005;33:1928-35; quiz 1936. [PMID: 16148461] Google Scholar4. Sypula WT, Kale-Pradhan PB. Therapeutic dilemma of fluconazole prophylaxis in intensive care. Ann Pharmacother. 2002;36:155-9. [PMID: 11816244] CrossrefMedlineGoogle Scholar5. Wenzel RP, Gennings C. Bloodstream infections due to Candida species in the intensive care unit: identifying especially high-risk patients to determine prevention strategies. Clin Infect Dis. 2005;41 Suppl 6 S389-93. [PMID: 16108005] CrossrefMedlineGoogle Scholar6. Schuster MG, Edwards JE, Sobel JD, Darouiche RO, Karchmer AW, Hadley S, et al. Empirical fluconazole versus placebo for intensive care unit patients. A randomized trial. Ann Intern Med. 2008;149:83-90. LinkGoogle Scholar7. Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43:25-31. [PMID: 16758414] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Temple University School of Medicine, Philadelphia, PA 19140.Disclosures: None disclosed.Corresponding Author: Thomas Fekete, MD, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEmpirical Fluconazole versus Placebo for Intensive Care Unit Patients Mindy G. Schuster , John E. Edwards Jr. , Jack D. Sobel , Rabih O. Darouiche , Adolf W. Karchmer , Susan Hadley , Gus Slotman , Helene Panzer , Pinaki Biswas , and John H. Rex Empirical Use of Fluconazole in Critically Ill Patients: Good Study, but What Was the Hold-up? Samuel A. Shelburne Metrics Cited ByEmpirical Use of Fluconazole in Critically Ill Patients: Good Study, but What Was the Hold-up?Samuel A. Shelburne, MD 15 July 2008Volume 149, Issue 2Page: 140-141KeywordsAntifungalsDrugsFeversIntensive care unitsMedical risk factorsPatientsProphylaxisSafety ePublished: 15 July 2008 Issue Published: 15 July 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...