Prophylactic antifungal therapy in the intensive care unit

Antifungal prophylaxis is regularly used during treatment of patients with some cancers, as subgroups with high rates of invasive fungal infections ar e readily identified; for these patients, prophylaxis has been shown to be of value. High-risk liver transplant recipients also benefit from antifunga l prophylaxis. Although the idea of extending this concept to the preventio n of candidal infections in the larger population of critically ill patient s who are seen in the intensive care unit (ICU) and who do not have neutrop enia is attractive, implementation of this strategy is difficult because of the widely varying characteristics of patients in the ICU. Two studies hav e shown the benefit of such prophylaxis, but the benefit was shown only in selected groups of patients who had an unusually high risk for invasive can didiasis. Although the concept is sound, broad-scale implementation of anti fungal prophylaxis would be premature and costly, both financially and with regard to resistance and toxicity. investigations are needed to define and prove the utility of predictive tools for the identification of patients i n the ICU who would benefit from prophylaxis.