The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial.
OBJECTIVE
To determine whether Candida glabrata colonization and invasive candidiasis (IC) increased among critically ill surgical patients 3 years after the introduction of fluconazole prophylaxis to a surgical intensive care unit (SICU).


BACKGROUND
Fluconazole prophylaxis has been shown in randomized clinical trials to reduce the occurrence of candidiasis in some patient populations, including high-risk SICU patients. One such trial was performed in The Johns Hopkins Hospital SICU in 1998. Whether the epidemiology of Candida colonization and IC has changed in SICUs where fluconazole prophylaxis is routinely utilized has not been adequately studied.


METHODS
We conducted a prospective, observational study of subjects admitted for > or = 3 days to the SICU of a large, urban, academic medical center, where fluconazole prophylaxis had been utilized for approximately 3 years. Surveillance fungal cultures of rectal/fecal swabs, urine, and endotracheal aspirates were performed on admission to the SICU, once weekly, and upon discharge from the SICU. Demographic and clinical data were collected. C. glabrata colonization and IC prevalence among patients in the prospective cohort were compared with the prevalence among SICU patients enrolled in the 1998 clinical trial of fluconazole for the prevention of candidiasis that was performed at the same institution.


RESULTS
C. glabrata colonization was not significantly more common among patients in the 2003 cohort as compared with patients in the 1998 trial (adjusted odds ratio [OR]: 0.90, 95% confidence interval [CI]: 0.57-1.41). Patients with IC in the 2003 cohort were not more likely than those in the 1998 trial to have IC due to C. glabrata (adjusted OR: 1.93, 95% CI: 0.20-18.98), while patients with IC in the 2003 cohort were less likely than patients in the 1998 trial to have acquired IC in the ICU (adjusted OR: 0.08, 95% CI: 0.009-0.82).


CONCLUSIONS
There was no increase in C. glabrata colonization or in the proportion of IC due to C. glabrata after a 3-year period of routine fluconazole prophylaxis for selected SICU patients.
Magill
Shelley S
SS
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-24, Atlanta, GA 30333, USA. smagill@cdc.gov
Swoboda
Sandra M
SM
Shields
Christine E
CE
Colantuoni
Elizabeth A
EA
Fothergill
Annette W
AW
Merz
William G
WG
Lipsett
Pamela A
PA
Hendrix
Craig W
CW
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D041221:Candida glabrata / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000517:prevention & control; D015169:Colony Count, Microbial; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D005500:Follow-Up Studies; D016469:Fungemia / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents; D015725:Fluconazole