Fluconazole Prophylaxis of Severe Candida Infection in Trauma and Postsurgical Patients: A Prospective, Double-Blind, Randomized, Placebo-Controlled Trial

Ables, Adrienne Z.; Blumer, Nancy A.; Valainis, Gregory T.; Godenick, Mark T.; Kajdasz, Daniel K.; Palesch, Yuko Y.

doi:10.1097/00019048-200009040-00006

Cited by 55 publications

(28 citation statements)

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“…This can be seen in Table 12, where the rank order of resistance to voriconazole parallels that of fluconazole. This has been manifested clinically where patients with C. glabrata fungemia, all with fluconazole exposure, failed treatment with voriconazole (2,140,186). The isolates in each instance were resistant to fluconazole (MIC Ն 64 g/ml) and demonstrated high MICs for voriconazole (MIC ϭ 2 g/ml to 4 g/ml), itraconazole (MIC Ն 16 g/ml), and posaconazole (MIC Ͼ 16 g/ml).…”

Section: Trends In Antifungal Susceptibility In Relation To Time Geomentioning

confidence: 99%

“…Taken individually, the various clinical trials of antifungal prophylaxis in high-risk ICU patients each demonstrate that meaningful prophylaxis is possible (2,69,82,111,190,196,258,263,267,272,320,325), although the effect on mortality and the ecological impact in terms of antifungal resistance are less clear. In an effort to provide a systematic synthesis of the benefits and harms of antifungal prophylaxis in the nonneutropenic ICU patient, several groups have conducted metaanalyses of the randomized trials in this area (Table 24) (45,103,233,270,295).…”

Section: Prevention and Prophylaxismentioning

confidence: 99%

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Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem

2007

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SUMMARY Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality in the United States. We examined data from the National Center for Health Statistics and reviewed recent literature in order to update the epidemiology of IC. IC-associated mortality has remained stable, at approximately 0.4 deaths per 100,000 population, since 1997, while mortality associated with invasive aspergillosis has continued to decline. Candida albicans remains the predominant cause of IC, accounting for over half of all cases, but Candida glabrata has emerged as the second most common cause of IC in the United States, and several less common Candida species may be emerging, some of which can exhibit resistance to triazoles and/or amphotericin B. Crude and attributable rates of mortality due to IC remain unacceptably high and unchanged for the past 2 decades. Nonpharmacologic preventive strategies should be emphasized, including hand hygiene; appropriate use, placement, and care of central venous catheters; and prudent use of antimicrobial therapy. Given that delays in appropriate antifungal therapy are associated with increased mortality, improved use of early empirical, preemptive, and prophylactic therapies should also help reduce IC-associated mortality. Several studies have now identified important variables that can be used to predict risk of IC and to help guide preventive strategies such as antifungal prophylaxis and early empirical therapy. However, improved non-culture-based diagnostics are needed to expand the potential for preemptive (or early directed) therapy. Further research to improve diagnostic, preventive, and therapeutic strategies is necessary to reduce the considerable morbidity and mortality associated with IC.

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Section: Trends In Antifungal Susceptibility In Relation To Time Geomentioning

confidence: 99%

Section: Prevention and Prophylaxismentioning

confidence: 99%

Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem

2007

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“…There was substantial variability among studies in duration of prophylaxis (medians or means ranging from 5 days to 29 months), dose of fluconazole, and methods and frequency of assessing colonization. Specific information on frequency of autopsies or of empiric antifungal therapy, allowed in one study, 25 was not available. The subgroup on duration of prophylaxis >2 months, which included six studies, 22e24,32e34 overlapped with the subgroup on outpatients, which included five studies.…”

Section: Description Of the Studiesmentioning

confidence: 99%

Risk of resistance associated with fluconazole prophylaxis: Systematic review

Brion

Uko

Goldman³

2007

Journal of Infection

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“…Older studies, performed 15 years ago [44,45], did not provide any information on this aspect. More surprisingly, more recent studies did not comment on this point [11,46].…”

Section: Influence Of Prophylactic Antifungal Therapymentioning

confidence: 97%