Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients:: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination
Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients:: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination
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DOI：
10.1007/s00134-002-1540-y
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发表时间：
2002-12-01
影响因子：
38.9
通讯作者：
Pittet, D
中科院分区：
文献类型：
--
作者：
Garbino, J;Lew, DP;Pittet, D
目的：念珠菌属引起的感染。是危重患者发病和死亡的主要原因，通常由内源性定植发展而来。我们评估了在选择性消化道去污方案中加入氟康唑预防念珠菌感染的有效性。设计和设置：我们在一家大型大学医院的内科和外科重症监护室患者中进行了一项前瞻性、随机、双盲、安慰剂对照试验。患者：所有成年患者机械通气至少48小时，预计至少再保持72小时，并接受选择性消化道去污，干预：患者随机分配氟康唑100 mg/天（n=103）或安慰剂（n=101）。测量和结果：氟康唑组念珠菌感染发生率（5.8%）低于安慰剂组（16%;率比0.35; CI-95 0.11-0.94）。约90%的念珠菌血症发生在安慰剂组（氟康唑使用率比为0.10; CI-95为0.02-0.74）。氟康唑组治疗失败、念珠菌感染或定植增加的发生率为32%，安慰剂组为67%（P
Objective: Infections caused by Candida spp. are a major cause of morbidity and mortality in critically ill patients and usually develop from endogenous colonization. We assessed the effectiveness of adding fluconazole to a selective digestive decontamination regimen to prevent candidal infections. Design and setting: We performed a prospective, randomized, double-blind, placebo-controlled trial among medical and surgical intensive care unit patients at a large university hospital. Patients: All adult patients mechanically ventilated for at least 48 h with an expectation to remain so for at least an additional 72 h, and receiving selective decontamination of the digestive tract, Interventions: Patients were randomly assigned fluconazole 100 mg daily (n=103) or placebo (n=101). Measurements and results: Candida infections occurred less frequently in the fluconazole group (5.8%) than in the placebo group (16%; rate ratio 0.35; Cl-95 0.11-0.94). Some 90% of candidemia episodes occurred in the placebo group (rate ratio for fluconazole use 0.10; Cl-95 0.02-0.74). The rate of treatment failure, development of candidal infection, or increased colonization, was 32% in the fluconazole group and 67% in the placebo group (P