Inadequate Proof of Adverse Outcome Due to the Use of Fluconazole in Critically Ill Patients

Rocco et al¹ found that patients treated with fluconazole had a longer length of stay in the intensive care unit and hospital and a higher mortality. This study has several shortcomings, limiting the conclusions being made. The patient groups are not comparable. The authors should have used the Acute Physiology and Chronic Health Evaluation III expected mortality instead of the score when they compared groups for outcome, as underlying disease can make an important difference on mortality. Furthermore, the fluconazole-treated patients are more debilitated and sick, suggested by the higher use of steroids and antibiotics and the higher number of yeast infection sites. In general, fungal infections occur in patients with a strongly debilitated physical condition who are already hospitalized for a longer period.² Fungal infections might have an attributable mortality.³ Hence, we are convinced that the excess length of stay as well as the worse prognosis of these patients is more a result of this population being less healthy rather than a result of the use of fluconazole.