nystatin-a1 and Fungemia

Fungemia is a serious problem within neonatal intensive care units around the world. Premature infants are at high risk for this complication, which is often fatal. Prophylaxis for invasive fungal infection has been practiced worldwide in different settings and with various patient groups. Both oral and intravenous drugs have been used with some success. In the population of preterm infants, oral nystatin, intravenous fluconazole, and intravenous amphotericin B have all been cited as possible drugs for prophylactic use. Intravenous fluconazole has emerged as the best choice for chemoprophylaxis in premature infants.

Topics: Administration, Intravenous; Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Candidemia; Fluconazole; Fungemia; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Malassezia; Nystatin; Zygomycosis

A prospective, randomized study was conducted to determine if prophylactic antifungal agents prevented yeast colonization (YC) or yeast sepsis (YS), or if they diminished mortality in 292 critically ill adult (nontransplant/nonburned) surgical and trauma patients admitted to the SICU for 48 hours or longer. Patients were randomized to receive (group I) no therapy, (group II) clotrimazole 10 mg three times a day, (group III) ketoconazole 200 mg per day, or (group IV) nystatin 2 million units every 6 hours. For comparison patients were stratified by the criteria of Slotman and Burchard into high risk (> or = 3 risk factors) and low risk (< 3 risk factors). Fifty patients (17%) had yeast colonization, nine (3.1%) had yeast sepsis, and 41 (14%) died. Stepwise logistic regression analysis of yeast colonization and sepsis using the variables APACHE II scores > 10, need for ventilator support > 48 hours, and 14 risk factors (Slotman and Burchard) showed that treatment with three or more antibiotics, APACHE II > 10, and ventilatory support > 48 hours were the only three variables that were significant predictors of yeast colonization and sepsis. There was no significant difference between the four groups with regard to YC (23%, 18%, 12%, and 15%, respectively), YS (3%, 1%, 2%, and 7%, respectively), or mortality (15%, 14%, 6%, and 20%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Candida; Candidiasis; Clotrimazole; Colony Count, Microbial; Critical Illness; Cross Infection; Female; Fungemia; Humans; Incidence; Intensive Care Units; Ketoconazole; Length of Stay; Logistic Models; Male; Middle Aged; Multiple Trauma; Nystatin; Postoperative Complications; Premedication; Prospective Studies; Risk Factors; Severity of Illness Index

Selective decontamination of the digestive tract (SDD) with oral nystatin was evaluated as a measure to control an outbreak of Candida infection in a neonatal intensive care unit (NICU). Seventy-six out of 106 neonates who carried Candida spp. received the main study manoeuvre (the application of oral nystatin in the throat and stomach) during the 12-month open trial. One third of the neonates weighed < 1500 g whilst about half were being ventilated. The mean stay was 33.2 d (SD +/- 46.9). Two cases with candidaemia within a fortnight were associated with a yeast carriage rate in the NICU of about 50%; more than 80% of the isolates were Candida parapsilosis. During the implementation period there were four new neonates with fungaemia caused by C. parapsilosis. Once the carriage rate dropped below 5% (P < 0.001), no new cases of systemic infection with the outbreak strain were recognized in the following 8 months. It took 3.5 months to control the outbreak. The observation that all other clinical diagnostic samples were free from Candida suggests that translocation from throat or gut into the systemic circulation occurred. SDD with oral nystatin was effective in reducing the yeast carriage index (mean index 1.93, before SDD; 0.45, after SDD; P < 0.001). A significant reduction of carriage, both in rates and indices, is thought to have contributed to the control of this candida outbreak.

Topics: Candidiasis; Carrier State; Digestive System; Disease Outbreaks; England; Fungemia; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Nystatin; Pharynx

Invasive fungal infection is an important cause of mortality and morbidity in extremely preterm babies. Colonisation with Candida is a risk factor for systemic infection. A policy of oral nystatin prophylaxis was introduced in November 2000 with the aim of reducing the incidence of invasive fungaemia.. To determine whether this policy had reduced the rates of fungal colonisation and invasive fungal infection.. All neonates of <33 weeks' gestation born between 1998 and 2003 were studied. Neonates born between January 1998 and October 2000 who did not receive nystatin prophylaxis (group A) were compared with those born between November 2000 and December 2003 who received nystatin prophylaxis (group B). Infant details, blood culture results and the results of weekly surface swabs were recorded.. 1459 neonates (group A = 724 , group B = 735) of <33 weeks' gestation were admitted in the study period. There were no differences in birth weight, gestation, gender or proportion of babies transferred in from other units between the groups. There was a reduction in colonisation from 257 (35.5%) in group A to 132 (18%) in group B. The incidence of invasive fungaemia decreased from 30 (4.1%) to 13 (1.8%) between the two groups. There was also a reduction in mortality between the two groups from 17.8% to 11.8%.. The introduction of a prophylactic nystatin administration policy for babies born before 33 weeks was associated with a significant reduction in fungal colonisation and invasive fungal infection.

Topics: Antifungal Agents; Candida; Candidiasis; Drug Evaluation; Female; Fungemia; Humans; Infant Care; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Nystatin; Retrospective Studies

Omiganan, a bactericidal and fungicidal cationic peptide being developed as a topical gel for prevention of catheter-associated infections, inhibited commonly occurring fungal pathogens including Candida spp. (106 isolates) at

Topics: Antifungal Agents; Antimicrobial Cationic Peptides; Aspergillosis; Aspergillus; Candida; Candidiasis; Catheterization, Central Venous; Dose-Response Relationship, Drug; Drug Resistance, Fungal; Fungemia; Fungi; Humans; Microbial Sensitivity Tests

Topics: Antifungal Agents; Candidiasis; Fluconazole; Fungemia; Gestational Age; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Meningitis, Fungal; Nystatin; Premature Birth; Prevalence; United States

Topics: Administration, Cutaneous; Antifungal Agents; Burns; Candidiasis; Cross Infection; Fungemia; Humans; Nystatin

The incidence of opportunistic infections after thermal injury is high. Since 1985, we have been practicing Candida prophylaxis using nystatin "swish-and-swallow" and topical therapy. Patients treated between 1980 and 1984 served as controls and received no Candida prophylaxis. Although mean burn size, full-thickness injury, and age were comparable, the incidence of Candida colonization (26.7% vs 15.6%), infection (21.3% vs 10.0%), and sepsis (12.2% vs none) was significantly different between control and nystatin-treated groups, respectively. With prophylaxis, the incidence of Candida wound infection has been significantly reduced, and systemic candidiasis has been eradicated, eliminating the need for toxic systemic antifungal agents.

Topics: Administration, Buccal; Administration, Topical; Burns; Candidiasis; Child; Child, Preschool; Fungemia; Humans; Nystatin; Retrospective Studies; Wound Infection