ASSESSMENT OF PRE-EMPTIVE TREATMENT TO PREVENT CANDIDA INFECTION IN CRITICALLY ILL SURGICAL PATIENTS

Piarroux R 1 , Grenouillet F 1 , Balvay P 2 , Gouget-Tran V 1 , Blasco G 2 , Millon L 1 , Boillot A 2

Author address: 

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Abstract: 

Background. In critically ill surgical patients, occurrence of severe Candida spp. infection can be predicted by determination of a corrected colonization index (CCI) as defined by Pittet et al (Ann Surg, 1994). Although Pittet demonstrated that with a CCI threshold of 0.4, further severe candidosis could be predicted, ours is the first study to assess whether or not early antifungal therapy can help to prevent candidosis in patients with CCI•••• 0.4. Material and methods. During a 20-month prospective period, patients admitted to our surgical intensive care unit (SICU) were tested for CCI, at admittance and once per week until discharge. Those having CCI•••• 0.4 were immediately treated with fluconazole 400 mg/day for two weeks (pre-emptive strategy). Incidence of severe candidosis in SICU was measured during the period of the study and compared to that measured in the two years preceding the study (retrospective period). Only patients who stayed more than 4 days in the ICU were included in assessment. Results. During the retrospective period, 32 patients out of 460 presented with proven severe candidosis. Ten of them (2.2 %) acquired it during their stay in the ICU and 22 (4.8%) presented with infection diagnosed at admittance to the ICU. During the prospective period, 18 patients out of 403 (4.5%) presented with proven severe candidosis, which was diagnosed at admittance. Among the remaining patients, 86 presented with ICC•••• 0.4 and were subjected to pre-emptive antifungal treatment. No acquired candidosis was diagnosed: not in patients submitted to pre-emptive treatment, or in patients having ICC
2003

abstract No: 

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Full conference title: 

The 15 th Congress of the International Society for Human and Animal Mycology
    • ISHAM 15th (2003)