Antifungal prophylaxis and pre-emptive therapy
Abstract
In recent years, several reports have underlined the increasing role of fungal infections as a cause of morbidity and mortality in hospitalized non-haematological patients. For this reason, and also in light of the high mortality rate associated with these infections, chemoprophylaxis has been advocated for surgical patients hospitalized in intensive care units (ICUs). The available evidence suggests that the triazoles fluconazole and itraconazole are able to decrease Candida colonization and possibly infection compared with placebo, but this result has only been obtained in high-risk patients undergoing repeated surgical procedures for tertiary peritonitis. Consequently, triazole antifungal prophylaxis should be used with caution, and only in patients at high risk of invasive candidiasis, including high-risk surgical and ICU patients. A pre-emptive approach, defined as initiating antifungal treatment without confirmation of fungal infection, seems to be effective and safe.
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A few meta-analyses have suggested potential mortality benefits with fluconazole prophylaxis; however, with an incidence of 1% to 2% in most ICU populations, more than 200 patients would need to undergo prophylaxis to prevent 1 infection.
“A few meta-analyses have suggested potential mortality benefits with fluconazole prophylaxis; however, with an incidence of 1% to 2% in most ICU populations, more than 200 patients would need to undergo prophylaxis to prevent 1 infection.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [186]
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Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting
Lepak, A., & Andes, D. (2011) · Critical Care Clinics · doi:10.1016/j.ccc.2010.11.001 · Cited by 62 · see citing works
- Authors
- Viscoli, C.
- Affiliations
- Ospedale Policlinico San Martino (IT)
- Corresponding author
- Viscoli, Claudio
- Venue
- Drugs
- Published
- 2009-11
- Volume
- 69
- Issue
- Supplement 1
- Pages
- 75-78
- ISSN
- 0012-6667 (ISSN-L)
- OpenAlex
- W2037072263
- Cited by
- 18
- References
- 26
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 1 · 2018: 1 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drugs (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Gilead Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- antifungal prophylaxis, preemptive antifungal therapy, invasive candidiasis, Candida colonization, fluconazole, itraconazole, triazoles, intensive care unit patients, surgical patients, tertiary peritonitis, fungal infection
- MeSH terms
- Antifungal Agents, Candidiasis, Critical Care, Cross Infection, Humans, Mycoses, Risk
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