Comment on "Prevention of severe Candida infections in non-neutropenic, high-risk, critically ill patients," by Garbino et al.

Excerpt

Sir: We read with interest the description by Garbino et al. [1] purporting to evaluate a randomised, double-blind, placebo-controlled trial in patients treated with selective digestive decontamination (SDD) in an attempt to prevent severe Candida infections in nonneutropenic, high-risk, critically ill patients. However, the title is very misleading for three reasons: (a) severe Candida infections were not prevented, (b) patients were not treated with SDD, and (c) the intervention assessed is not mentioned. The manoeuvre studied in this trial was systemic fluconazole vs. placebo. Patients did not receive SDD but solely oropharyngeal decontamination using an antimicrobial solution without an antifungal [2]. Intestinal decontamination was not administered to any patients. Most importantly, severe Candida infections, the primary endpoint of the study, were not prevented by fluconazole, as the study was underpowered to one-half the 10% severe infection rate. More than 500 patients per arm would have been required to give the trial a power of 85% [3]. …