Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: A meta-analysis of randomized, placebo-controlled trials

Konstantinos Z. Vardakas, George Samonis, Argyris Michalopoulos, Elpidoforos S. Soteriades, Matthew E. Falagas

Research output: Contribution to journalReview articlepeer-review

74 Citations (Scopus)


Objective: The use of antifungal prophylaxis remains controversial in most populations including surgical intensive care unit patients. A meta-analysis of randomized controlled trials was performed to evaluate the safety and effectiveness of azoles as antifungal prophylaxis in high-risk patients receiving treatment in the surgical intensive care unit. Data Source: Data were obtained from PubMed, Current Contents, Cochrane central register of controlled trials, and references from relevant articles. Study Selection: Randomized controlled trials using azoles as antifungal prophylaxis vs. placebo were included in the study. Data Extraction: Two independent reviewers extracted data concerning the development of fungal infections (superficial or invasive), adverse effects, and mortality. Synthesis: Six randomized controlled trials were included in the main analysis. Publication bias and statistically significant heterogeneity were not observed among the analyzed studies. Patients receiving antifungal prophylaxis developed fewer episodes of candidemia (odds ratio [OR] = 0.28, 95% confidence interval [CI] 0.09-0.86), nonbloodstream invasive fungal infections (OR = 0.26, 95% CI 0.12-0.53), and noninvasive (superficial) fungal infections (OR = 0.22, 95% CI 0.11-0.43), respectively. No reduction in mortality was observed among patients who received azole prophylaxis (OR = 0.74, 95% CI 0.52-1.05). There was no significant difference in reported adverse effects (OR = 1.28, 95% CI 0.82-1.98). Conclusions: Despite its limitations, our meta-analysis suggests that the prophylactic use of azoles in high-risk surgical intensive care unit patients is associated with a reduction of fungal infections but not in all-cause mortality. However, although not noted in the analyzed randomized controlled trials, there is concern about the use of azoles due to possible shift toward non-albicans species and development of resistance to azoles.

Original languageEnglish
Pages (from-to)1216-1224
Number of pages9
JournalCritical Care Medicine
Issue number4
Publication statusPublished - Apr 2006
Externally publishedYes


  • Amphotericin B
  • Azole
  • Fluconazole
  • Itraconazole
  • Ketoconazole
  • Polyene
  • Prevention
  • Surgery
  • Transplantation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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