Routine Prophylactic Antifungal Agents (Clotrimazole, Ketoconazole, and Nystatin) in nontransplant/nonburned Critically Ill Surgical and Trauma Patients

J Trauma. 1994 Jan;36(1):20-5; discussion 25-6. doi: 10.1097/00005373-199401000-00004.

Abstract

A prospective, randomized study was conducted to determine if prophylactic antifungal agents prevented yeast colonization (YC) or yeast sepsis (YS), or if they diminished mortality in 292 critically ill adult (nontransplant/nonburned) surgical and trauma patients admitted to the SICU for 48 hours or longer. Patients were randomized to receive (group I) no therapy, (group II) clotrimazole 10 mg three times a day, (group III) ketoconazole 200 mg per day, or (group IV) nystatin 2 million units every 6 hours. For comparison patients were stratified by the criteria of Slotman and Burchard into high risk (> or = 3 risk factors) and low risk (< 3 risk factors). Fifty patients (17%) had yeast colonization, nine (3.1%) had yeast sepsis, and 41 (14%) died. Stepwise logistic regression analysis of yeast colonization and sepsis using the variables APACHE II scores > 10, need for ventilator support > 48 hours, and 14 risk factors (Slotman and Burchard) showed that treatment with three or more antibiotics, APACHE II > 10, and ventilatory support > 48 hours were the only three variables that were significant predictors of yeast colonization and sepsis. There was no significant difference between the four groups with regard to YC (23%, 18%, 12%, and 15%, respectively), YS (3%, 1%, 2%, and 7%, respectively), or mortality (15%, 14%, 6%, and 20%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Candida / growth & development*
  • Candidiasis / drug therapy*
  • Candidiasis / epidemiology
  • Candidiasis / etiology
  • Candidiasis / microbiology
  • Clotrimazole / pharmacology
  • Clotrimazole / therapeutic use*
  • Colony Count, Microbial
  • Critical Illness
  • Cross Infection / drug therapy*
  • Cross Infection / epidemiology
  • Cross Infection / etiology
  • Cross Infection / microbiology
  • Female
  • Fungemia / drug therapy*
  • Fungemia / epidemiology
  • Fungemia / etiology
  • Fungemia / microbiology
  • Humans
  • Incidence
  • Intensive Care Units
  • Ketoconazole / pharmacology
  • Ketoconazole / therapeutic use*
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Multiple Trauma / complications*
  • Multiple Trauma / mortality
  • Nystatin / pharmacology
  • Nystatin / therapeutic use*
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / microbiology
  • Premedication*
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index

Substances

  • Nystatin
  • Clotrimazole
  • Ketoconazole