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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 ; Schilling, Julian ; Geroulanos, Stefanos ; Glauser, Michel P ; Calandra, Thierry

Critical care medicine, 1999-06, Vol.27 (6), p.1066-1072 [Periódico revisado por pares]

Hagerstown, MD: Lippincott Williams & Wilkins, Inc

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Título:
Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients
Autor: Eggimann, Philippe ; Francioli, Patrick ; Bille, Jacques ; Schneider, Remy ; Wu, Mei-Miau ; Chapuis, Germain ; Chiolero, Rene ; Pannatier, Andre ; Schilling, Julian ; Geroulanos, Stefanos ; Glauser, Michel P ; Calandra, Thierry
Assuntos: Abdomen - microbiology ; Abdomen - surgery ; Adult ; Aged ; Aged, 80 and over ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antifungal agents ; Antifungal Agents - therapeutic use ; Biological and medical sciences ; Candida - isolation & purification ; Candidiasis - prevention & control ; Critical Care ; Double-Blind Method ; Equipment Contamination ; Female ; Fluconazole - therapeutic use ; Humans ; Infusions, Intravenous ; Male ; Medical sciences ; Middle Aged ; Peritonitis - drug therapy ; Peritonitis - microbiology ; Pharmacology. Drug treatments ; Postoperative Complications - prevention & control ; Prospective Studies ; Risk Factors
É parte de: Critical care medicine, 1999-06, Vol.27 (6), p.1066-1072
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
ObjectType-News-3
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Descrição: OBJECTIVETo evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGNRandomized, prospective, double-blind, placebo-controlled study. SETTINGTwo university-affiliated hospitals in Switzerland. PATIENTSForty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONSProphylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTSPatients 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 (intraabdominal 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. CONCLUSIONSFluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients. (Crit Care Med 1999; 27:1066-1072)
Editor: Hagerstown, MD: Lippincott Williams & Wilkins, Inc
Idioma: Inglês

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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 ; Schilling, Julian ; Geroulanos, Stefanos ; Glauser, Michel P ; Calandra, Thierry

Hagerstown, MD: Lippincott Williams & Wilkins, Inc

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