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Cited by 414Antifungal resistance and susceptibilitySurgical site infection preventionNosocomial Infections in ICU

Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients

Eggimann, Philippe, Francioli, Patrick, Bille, Jacques, Schneider, Remy, Wu, Mei-Miau, Chapuis, Germain, Chiolero, Rene, Pannatier, Andre +4 more·1999·Critical Care Medicine
DOI 10.1097/00003246-199906000-00019
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Abstract

OBJECTIVE: To evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGN: Randomized, prospective, double-blind, placebo-controlled study. SETTING: Two university-affiliated hospitals in Switzerland. PATIENTS: Forty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONS: Prophylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated daily, and specimens for culture were obtained three times per week during prophylaxis. The primary study end points were the frequency of and the time to intra-abdominal Candida infections. Secondary end points were the frequency of candidiasis (intra-abdominal and extra-abdominal) and the emergence or persistence of Candida colonization. Among patients who were not colonized at study entry, Candida was isolated from surveillance cultures during prophylaxis in 15% of the patients in the fluconazole group and in 62% of the patients in the placebo group (relative risk, 0.25; 95% confidence interval, 0.07 to 0.96; p = .04). Candida peritonitis occurred in one of 23 patients (4%) who received fluconazole and in seven of 20 patients (35%) who received placebo (relative risk, 0.12; 95% confidence interval, 0.02 to 0.93; p = .02). In addition, one catheter-related Candida albicans sepsis occurred in a fluconazole-treated patient. Thus, overall, candidiasis developed in two fluconazole patients and seven placebo patients (relative risk, 0.25; 95% confidence interval, 0.06 to 1.06; p = .06). C. albicans accounted for 87% of the Candida species isolated before or during prophylaxis, and all C. albicans strains were susceptible to fluconazole. Fluconazole was well tolerated, and adverse events occurred at similar frequencies in both treatment groups. CONCLUSIONS: Fluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients.

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Crossref · 10.1097/00003246-199906000-00019

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  • Fluconazole (400 mg/day) reduced the likelihood of developing symptomatic Candida peritonitis in surgical patients with recurrent gastrointestinal perforations or anastomotic leakage.

    “A recent small but placebo-controlled trial demonstrated that fluconazole (400 mg/day) reduced the likelihood of developing symptomatic Candida peritonitis in surgical patients with recurrent gastrointestinal perforations or anastomotic leakage [214].”

    From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [214]

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Authors
Eggimann, P., Francioli, P., Bille, J., Schneider, R., Wu, M.-M., Chapuis, G., Chiolero, R., Pannatier, A., Schilling, J., Geroulanos, S., Glauser, M. P., & Calandra, T.
Affiliations
Centre Hospitalier Universitaire Vaudois (CH)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1999-06
Volume
27
Issue
6
Pages
1066-1072
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/00003246-199906000-00019
OpenAlex
W2037167636
Cited by
414
References
38
Citations by year
2026: 5 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 19 · 2019: 8 · 2018: 3 · 2017: 7 · 2016: 6 · 2015: 18 · 2014: 22 · 2013: 20 · 2012: 16
FWCI
13.09
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
fluconazole, antifungal prophylaxis, intra-abdominal candidiasis, Candida albicans, Candida peritonitis, gastrointestinal perforation, anastomotic leakage, Candida colonization, catheter-related sepsis, high-risk surgical patients
MeSH terms
Abdomen, Adult, Aged, Aged, 80 and over, Antifungal Agents, Candida, Candidiasis, Critical Care, Double-Blind Method, Equipment Contamination, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Peritonitis, Postoperative Complications, Prospective Studies, Risk Factors, Fluconazole

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