Routine prophylactic antifungal agents (clotrimazole, ketoconazole, and nystatin) in nontransplant/nonburned critically ill surgical and trauma patients.
A prospective, randomized study was conducted to determine if prophylactic antifungal agents prevented yeast colonization (YC) or yeast sepsis (YS), or if they diminished mortality in 292 critically ill adult (nontransplant/nonburned) surgical and trauma patients admitted to the SICU for 48 hours or longer. Patients were randomized to receive (group I) no therapy, (group II) clotrimazole 10 mg three times a day, (group III) ketoconazole 200 mg per day, or (group IV) nystatin 2 million units every 6 hours. For comparison patients were stratified by the criteria of Slotman and Burchard into high risk (> or = 3 risk factors) and low risk (< 3 risk factors). Fifty patients (17%) had yeast colonization, nine (3.1%) had yeast sepsis, and 41 (14%) died. Stepwise logistic regression analysis of yeast colonization and sepsis using the variables APACHE II scores > 10, need for ventilator support > 48 hours, and 14 risk factors (Slotman and Burchard) showed that treatment with three or more antibiotics, APACHE II > 10, and ventilatory support > 48 hours were the only three variables that were significant predictors of yeast colonization and sepsis. There was no significant difference between the four groups with regard to YC (23%, 18%, 12%, and 15%, respectively), YS (3%, 1%, 2%, and 7%, respectively), or mortality (15%, 14%, 6%, and 20%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Savino
J A
JA
Westchester County Medical Center, New York Medical College, Valhalla.
Agarwal
N
N
Wry
P
P
Policastro
A
A
Cerabona
T
T
Austria
L
L
D000368:Aged; D002175:Candida / Q000254:growth & development*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D003022:Clotrimazole / Q000494:pharmacology / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007654:Ketoconazole / Q000494:pharmacology / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000401:mortality; D009761:Nystatin / Q000494:pharmacology / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D011292:Premedication; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D009761:Nystatin; D003022:Clotrimazole; D007654:Ketoconazole