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Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis
Andrew F Shorr1, Kevin Chung, William L Jackson
1Washington Hospital Center, Medstar, Potomac, MD, USA. afshorr@dnamail.com
Critical Care Medicine
|September 9, 2005
Summary
Fluconazole prophylaxis effectively reduces fungal infections in critically ill surgical patients. However, this preventative strategy does not improve patient survival rates.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Fungal infections pose a significant threat to critically ill patients.
- Prophylactic antifungal agents are used to prevent invasive mycoses.
Purpose of the Study:
- To assess the efficacy of fluconazole prophylaxis in reducing fungal infections and mortality in critically ill surgical patients.
Main Methods:
- Meta-analysis of four randomized, placebo-controlled trials.
- Included 626 critically ill surgical patients.
Main Results:
- Fluconazole significantly decreased the incidence of fungal infections (OR, 0.44; 95% CI, 0.27-0.72).
- No significant difference in mortality was observed between fluconazole and placebo groups (OR, 0.87; 95% CI, 0.59-1.28).
- Fluconazole did not alter the rate of candidemia.
Conclusions:
- Fluconazole prophylaxis is effective in preventing fungal infections in surgical intensive care units (SICUs).
- This strategy does not confer a survival benefit.
- Potential for antifungal resistance and emergence of non-albicans species necessitates careful consideration.
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