Tags

Type your tag names separated by a space and hit enter

The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial.
Ann Surg. 2009 Apr; 249(4):657-65.AnnS

Abstract

OBJECTIVE

To determine whether Candida glabrata colonization and invasive candidiasis (IC) increased among critically ill surgical patients 3 years after the introduction of fluconazole prophylaxis to a surgical intensive care unit (SICU).

SUMMARY BACKGROUND DATA

Fluconazole prophylaxis has been shown in randomized clinical trials to reduce the occurrence of candidiasis in some patient populations, including high-risk SICU patients. One such trial was performed in The Johns Hopkins Hospital SICU in 1998. Whether the epidemiology of Candida colonization and IC has changed in SICUs where fluconazole prophylaxis is routinely utilized has not been adequately studied.

METHODS

We conducted a prospective, observational study of subjects admitted for > or = 3 days to the SICU of a large, urban, academic medical center, where fluconazole prophylaxis had been utilized for approximately 3 years. Surveillance fungal cultures of rectal/fecal swabs, urine, and endotracheal aspirates were performed on admission to the SICU, once weekly, and upon discharge from the SICU. Demographic and clinical data were collected. C. glabrata colonization and IC prevalence among patients in the prospective cohort were compared with the prevalence among SICU patients enrolled in the 1998 clinical trial of fluconazole for the prevention of candidiasis that was performed at the same institution.

RESULTS

C. glabrata colonization was not significantly more common among patients in the 2003 cohort as compared with patients in the 1998 trial (adjusted odds ratio [OR]: 0.90, 95% confidence interval [CI]: 0.57-1.41). Patients with IC in the 2003 cohort were not more likely than those in the 1998 trial to have IC due to C. glabrata (adjusted OR: 1.93, 95% CI: 0.20-18.98), while patients with IC in the 2003 cohort were less likely than patients in the 1998 trial to have acquired IC in the ICU (adjusted OR: 0.08, 95% CI: 0.009-0.82).

CONCLUSIONS

There was no increase in C. glabrata colonization or in the proportion of IC due to C. glabrata after a 3-year period of routine fluconazole prophylaxis for selected SICU patients.

Authors+Show Affiliations

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-24, Atlanta, GA 30333, USA. smagill@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19300221

Citation

Magill, Shelley S., et al. "The Epidemiology of Candida Colonization and Invasive Candidiasis in a Surgical Intensive Care Unit Where Fluconazole Prophylaxis Is Utilized: Follow-up to a Randomized Clinical Trial." Annals of Surgery, vol. 249, no. 4, 2009, pp. 657-65.
Magill SS, Swoboda SM, Shields CE, et al. The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial. Ann Surg. 2009;249(4):657-65.
Magill, S. S., Swoboda, S. M., Shields, C. E., Colantuoni, E. A., Fothergill, A. W., Merz, W. G., Lipsett, P. A., & Hendrix, C. W. (2009). The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial. Annals of Surgery, 249(4), 657-65. https://doi.org/10.1097/SLA.0b013e31819ed914
Magill SS, et al. The Epidemiology of Candida Colonization and Invasive Candidiasis in a Surgical Intensive Care Unit Where Fluconazole Prophylaxis Is Utilized: Follow-up to a Randomized Clinical Trial. Ann Surg. 2009;249(4):657-65. PubMed PMID: 19300221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial. AU - Magill,Shelley S, AU - Swoboda,Sandra M, AU - Shields,Christine E, AU - Colantuoni,Elizabeth A, AU - Fothergill,Annette W, AU - Merz,William G, AU - Lipsett,Pamela A, AU - Hendrix,Craig W, PY - 2009/3/21/entrez PY - 2009/3/21/pubmed PY - 2009/5/5/medline SP - 657 EP - 65 JF - Annals of surgery JO - Ann. Surg. VL - 249 IS - 4 N2 - OBJECTIVE: To determine whether Candida glabrata colonization and invasive candidiasis (IC) increased among critically ill surgical patients 3 years after the introduction of fluconazole prophylaxis to a surgical intensive care unit (SICU). SUMMARY BACKGROUND DATA: Fluconazole prophylaxis has been shown in randomized clinical trials to reduce the occurrence of candidiasis in some patient populations, including high-risk SICU patients. One such trial was performed in The Johns Hopkins Hospital SICU in 1998. Whether the epidemiology of Candida colonization and IC has changed in SICUs where fluconazole prophylaxis is routinely utilized has not been adequately studied. METHODS: We conducted a prospective, observational study of subjects admitted for > or = 3 days to the SICU of a large, urban, academic medical center, where fluconazole prophylaxis had been utilized for approximately 3 years. Surveillance fungal cultures of rectal/fecal swabs, urine, and endotracheal aspirates were performed on admission to the SICU, once weekly, and upon discharge from the SICU. Demographic and clinical data were collected. C. glabrata colonization and IC prevalence among patients in the prospective cohort were compared with the prevalence among SICU patients enrolled in the 1998 clinical trial of fluconazole for the prevention of candidiasis that was performed at the same institution. RESULTS: C. glabrata colonization was not significantly more common among patients in the 2003 cohort as compared with patients in the 1998 trial (adjusted odds ratio [OR]: 0.90, 95% confidence interval [CI]: 0.57-1.41). Patients with IC in the 2003 cohort were not more likely than those in the 1998 trial to have IC due to C. glabrata (adjusted OR: 1.93, 95% CI: 0.20-18.98), while patients with IC in the 2003 cohort were less likely than patients in the 1998 trial to have acquired IC in the ICU (adjusted OR: 0.08, 95% CI: 0.009-0.82). CONCLUSIONS: There was no increase in C. glabrata colonization or in the proportion of IC due to C. glabrata after a 3-year period of routine fluconazole prophylaxis for selected SICU patients. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19300221/The_epidemiology_of_Candida_colonization_and_invasive_candidiasis_in_a_surgical_intensive_care_unit_where_fluconazole_prophylaxis_is_utilized:_follow_up_to_a_randomized_clinical_trial_ L2 - http://Insights.ovid.com/pubmed?pmid=19300221 DB - PRIME DP - Unbound Medicine ER -