Prevention and therapy of fungal infection in severe acute pancreatitis: A prospective clinical study

Abstract

AIM:To investigate the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). METHODS:Seventy patients with SAP admitted from Jan. 1998 to Dec. 2002 were randomly divided into garlicin prevention group, fluconazole (low dosage) prevention group and control group. The incidence of fungal infection, the fungal clearance and mortality after treatment were compared. RESULTS:The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group (16 % vs 30 %, P<0.05 and 9 % vs 30 %, P<0.01, respectively). Amphotericin B or therapy-dose fluconazole had effects on patients with fungal infection in garlicin group and control group, but had no effects on patients with fungal infection in fluconzole group. CONCLUSION:

Choosing Optimal Antifungal Agents To Prevent Fungal Infections in Nonneutropenic Critically Ill Patients: Trial Sequential Analysis, Network Meta-analysis, and Pharmacoeconomic Analysis

“…The outcome of mortality was not reported for 1 of the 19 RCTs, and so this was not included in the all-cause mortality analysis (25). Untargeted antifungal treatment did not significant reduce the odds for all-cause mortality (odds ratio [OR] ϭ 0.89, 95% confidence interval [95%CI] ϭ 0.70 to 1.14, proportion of variation across studies due to heterogeneity rather than chance [I 2 ] ϭ 25.9%, Cochrane Q P ϭ 0.157) ( Table 1 and Fig.…”

“…An intention-to-treat analysis was performed in most of the studies (14 RCTs, 74%) (14,15,18,19,21,22,(24)(25)(26)(27)(30)(31)(32)(33).…”

Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: A meta-analysis of randomized, placebo-controlled trials*

“…Of those RCTs, 18 were excluded because amphotericin B or nystatin was used as part of a selective bowel decontamination regimen (10 -27), six because amphotericin B or nystatin alone or in combination with other antifungal agents was compared with various antifungal agents including azoles or the lipid forms of amphotericin B (28 -33), three because amphotericin B or nystatin was compared with placebo or no drug (34 -36), three because they compared the effectiveness of azole derivatives against placebo in nonsurgical, non-ICU patients (37)(38)(39), and three because they compared azoles with placebo in preterm, low-weight infants (40 -42). In addition, one RCT was excluded because one perioperative dose of fluconazole was used as prophylaxis (43), one because the primary outcome was the Candida colonization and/or infection of prosthetic devices in postlaryngectomy patients under prophylaxis with fluconazole (44), one because it compared the effectiveness of prophylactic itraconazole vs. fluconazole (45), one because it was conducted in a mixed lowand high-risk patient population and it was not placebo controlled (46), and one because it was performed in low-risk surgical patients (47).…”

The use of antibiotics for acute pancreatitis: Is there a role?

“…Primary fungal infections are found in less than 5% [7]. However, secondary Candida infections are found more frequently [18][19][20]. There is a recognition that Candida infections in patients with NP are related to the length of antibiotic treatment and are associated with increased morbidity and higher rates of mortality [14][15][16][17].…”