nystatin-a1 and Postoperative-Complications

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

An open study designed to compare the effectiveness and safety of clotrimazole troches with nystatin oral suspension in the prevention of oropharyngeal candidiasis was conducted. This study was performed as the troche form of clotrimazole was easier to administer and less costly than nystatin oral suspension. Sixty assessable patients were randomized to receive either clotrimazole troches (n = 32) or nystatin oral suspension (n = 28) for a 60-day period after receiving a renal allograft. The two groups were comparable in age, sex, type of transplant, and amount of immunosuppression. Both regimens were 100% effective in preventing the development of thrush in the patients studied. Adverse effects were infrequently seen in either group (one case of mild nausea in the clotrimazole group and three cases in the nystatin group). One patient chose to withdraw from the clotrimazole group, and eight patients withdrew from the nystatin group before completing 60 days of therapy (P = .002). Reasons given for withdrawal were the unpleasant taste of the drugs, or an inability to comply with the protocol. The cost of clotrimazole troches in the prophylactic doses given in this study was approximately one tenth that of nystatin oral suspension. Clotrimazole troches are effective, less expensive, and easier to self-administer than nystatin oral suspension.

Topics: Administration, Topical; Adolescent; Adult; Aged; Candidiasis, Oral; Clotrimazole; Female; Humans; Imidazoles; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nystatin; Pharyngeal Diseases; Postoperative Complications; Prospective Studies; Random Allocation; Suspensions; Tablets

Invasive aspergillosis seems to be on the rise, especially in immunocompromised children. Historically, only systemic amphotericin B has been effective against Aspergillus. Development of newer antifungal agents, such as voriconazole and caspofungin, has improved the treatment options available for aspergillosis, although no definitive management strategy has been established. Here we describe the use of topical voriconazole combined with systemic antifungal agents for cutaneous aspergillosis in a pediatric patient after bone marrow transplant.

Topics: Administration, Cutaneous; Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Combined Modality Therapy; Debridement; Dermatomycoses; Disease Susceptibility; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Injections, Subcutaneous; Nystatin; Postoperative Complications; Pyrimidines; Skin; Transplantation, Homologous; Triazoles; Voriconazole

Topics: Adolescent; Adult; Ampicillin; Analysis of Variance; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antifungal Agents; Bacterial Infections; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Feces; Graft Rejection; Humans; Infant; Liver Transplantation; Middle Aged; Mycoses; Nystatin; Postoperative Complications; Regression Analysis; Retrospective Studies; Risk Factors; Tobramycin

Topics: Animals; Bacteria, Aerobic; Bacterial Infections; Colistin; Drug Therapy, Combination; Enterobacteriaceae; Female; Intestine, Small; Liver; Liver Transplantation; Lung; Lymph Nodes; Mycoses; Nystatin; Postoperative Complications; Spleen; Swine; Tobramycin; Transplantation, Autologous; Vancomycin

Topics: Adolescent; Adult; Aerobiosis; Bacterial Infections; Candida; Candidiasis; Child; Colistin; Gentamicins; Gram-Negative Bacteria; Humans; Intestines; Liver Transplantation; Nystatin; Pharynx; Postoperative Complications; Rectum

Records of 65 surgical patients with positive fungal blood cultures were reviewed to address risk, overall mortality, and treatment. Negative urine cultures did not rule out sepsis. Staphylococcus epidermidis sepsis was present in 27 (42%) of the patients. In 70% of whom it occurred before or during fungemia. Increased mortality correlated with the use of multiple antibiotics, antibiotic use for prolonged periods, and with associated bacterial sepsis. Stopping antibiotic therapy did not reduce mortality. Amphotericin B reduced mortality in patients with dissemination, indicating that it is the treatment of choice for disseminated fungemia and that antibiotic therapy should not be discontinued when concomitant bacterial sepsis is present.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Blood; Child; Child, Preschool; Female; Fungi; Humans; Infant; Male; Middle Aged; Mycoses; Nystatin; Postoperative Complications; Staphylococcal Infections

21 of 41 patients developed clinically manifest or systemic Candida albicans infection 1-36 months after renal transplantation. Asymptomatic candiduria was diagnosed in all patients even before the onset of clinical symptoms. Fungal stomatitis was the most frequent clinical sign, followed by mycotic changes in the respiratory, genito-urinary (vaginitis) and gastro-intestinal tract. In five cases intrahepatic biliary stasis was diagnosed in the course of a Candida albicans septicaemia. In 12 patients with renal transplants it was possible, by treatment with nystatin, clotrimazole, flucytosine, miconazole and amphotericine B to control a generalized or clinically manifest Candida albicans infection. Three died of the septicaemia or meningoencephalitis, six as the result of bacterial superinfections. Inspection of the mouth is an important means of early diagnosing fungal infections. Antimycotic treatment should be started if fungal cultures from urine are repeatedly positive even if the clinical findings are still negative.

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Cholestasis; Clotrimazole; Female; Humans; Kidney Transplantation; Male; Meningoencephalitis; Miconazole; Middle Aged; Nystatin; Postoperative Complications; Sepsis; Transplantation, Homologous

During the two and a half year period from January 1971 through Jyly 1973, 23 patients had cultures positive for candida from intra-abdominal isolates. Most of these patients had intestinal or biliary fistulas or abscesses and were seriously ill. Major contributing factors to the development of candidal infections included the extensive use of multiple antibiotics, multiple operations, advanced age, and debility. Thirty additional patients had cultures positive for candida from skin and subcutaneous isolates. Candida appeared to contribute to the poor healing of wounds in some of these patients, particularly those with peripheral vascular ischemic lesions and decubitus ulcers. Antibiotics and concurrent diseases, such as diabetes, cancer, renal failure, and cardiovascular disease, were common factors relating to the development and growth of candida in these patients. There is often considerable difficulty in determing whether or not candida is only a contaminant or is an infectious agent contributing to the illness of the patient. This must be determined in each individual instance. In spite of the fact that candida appeared to be a significant infectious agent in many of these patients, specific antifungal therapy was used sparsely. It is suggested that appropriate antifungal drugs be used in patients with significant disease and that there should be greater awareness of the factors leading to the development of these extremely serious candidal infections.

Topics: Adult; Age Factors; Aged; Antifungal Agents; Candida; Candidiasis; Female; Humans; Infections; Male; Middle Aged; Nystatin; Postoperative Complications; Surgical Procedures, Operative; Surgical Wound Infection

Topics: Abortion, Septic; Adult; Amphotericin B; Anti-Bacterial Agents; Candida; Candidiasis; Carcinoma, Squamous Cell; Female; Genital Diseases, Female; Humans; Immunosuppressive Agents; Middle Aged; Nystatin; Postoperative Complications; Pregnancy; Uterine Cervical Neoplasms

Topics: Ampicillin; Anti-Bacterial Agents; Aspergillus; Gentamicins; Gingivitis, Necrotizing Ulcerative; Haemophilus influenzae; Heart Transplantation; Humans; Immunosuppressive Agents; Infections; Kanamycin; Klebsiella; Lung Abscess; Male; Methicillin; Middle Aged; Nystatin; Penicillin Resistance; Penicillins; Pericarditis; Pericardium; Postoperative Complications; Pseudomonas aeruginosa; Respiratory System; Serratia marcescens; Simplexvirus; Staphylococcus; Streptomycin; Suppuration; Transplantation, Homologous

Topics: Abortion, Septic; Amniotic Fluid; Animals; Aspergillosis; Aspergillus; Female; Fetal Diseases; Nystatin; Postoperative Complications; Pregnancy; Sheep; Sheep Diseases

Topics: Anti-Infective Agents; Colonic Diseases; Gastrointestinal Diseases; Humans; Kanamycin; Nystatin; Peritonitis; Postoperative Complications; Preoperative Care; Surgical Wound Infection; Wound Infection

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Child, Preschool; Chylothorax; Empyema; Humans; Male; Nystatin; Pleural Effusion; Postoperative Complications; Pulmonary Artery; Radiography, Thoracic; Subclavian Artery; Surgical Wound Infection; Tetralogy of Fallot

Topics: Aspergillosis; Aspergillus; Cerumen; Chlorides; Ear Diseases; Escherichia coli; Glucose; Humans; Hydrogen-Ion Concentration; Nystatin; Postoperative Complications; Pseudomonas aeruginosa; Staphylococcus; Sulfates

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Antifungal Agents; Aspergillosis; Biomedical Research; Candidiasis; Humans; Hydrocortisone; Mastoiditis; Mycoses; Nystatin; Otitis Media; Otolaryngology; Penicillium; Postoperative Complications; Surgical Procedures, Operative

Topics: Acremonium; Amphotericin B; Ascomycota; Candidiasis; Cataract; Cataract Extraction; Drug Therapy; Eye Diseases; gamma-Globulins; Griseofulvin; Humans; Mycoses; Nystatin; Postoperative Complications; Steroids; Toxicology