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Oral nystatin prophylaxis of Candida spp. colonization in ventilated critically ill patients

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Abstract

Objective

Colonization of multiple body sites is a leading risk factor for Candida spp. infection in intensive care unit (ICU) patients. We evaluated whether oral nystatin prophylaxis reduces Candida spp. colonization in ventilated ICU patients.

Design and setting

Prospective, randomized, open-label study with blinded assessment of the objective primary evaluation criterion in the medical-surgical ICU of a teaching hospital.

Patients

The study included 98 consecutive patients mechanically ventilated for at least 48 h (mean age 58±19 years; mean SAPS II 40±11), assigned to either treatment group (n=51) or control group (n=47). Study groups were comparable for age, SAPS II, reason for admission, and immune status.

Interventions

Patients were randomized to receive oral nystatin (treatment group; 3×106 U per day) or no nystatin (control group). Multiple body sites (trachea, stomach, rectum, urine, groin, and blood) were tested for Candida spp. on admission and then every 3 days by mycologists blinded to group assignment, and the colonization index was determined.

Results

Colonization by Candida spp. developed in 25% of controls but in none of the treated patients. In multivariate analysis, the absence of nystatin prophylaxis and ICU length of stay were independently associated with Candida spp. colonization. No invasive candidiasis was diagnosed in either study group.

Conclusions

Oral nystatin prophylaxis efficiently prevented Candida spp. colonization in ICU patients at low risk of developing invasive candidiasis. Further studies are needed to determine whether this strategy remains efficient in reducing Candida spp. infections in higher risk ICU patients.

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Acknowledgements

We gratefully thank Pr. Didier Pittet for his expertise and constructive critique of this manuscript.

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Authors and Affiliations

  1. Medical-Surgical ICU, Dupuytren Teaching Hospital, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France

    Sandrine Normand, Bruno François, Michel Bonnivard, Hervé Gastinne & Philippe Vignon

  2. Parasitology-Mycology Laboratory, Dupuytren Teaching Hospital, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France

    Marie-Laure Dardé & Bernard Bouteille

  3. Department of Biostatistics, Dupuytren Teaching Hospital, 2 Ave. Martin Luther King, , 87042, Limoges Cedex, France

    Pierre-Marie Preux

Authors
  1. Sandrine Normand
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  2. Bruno François
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  3. Marie-Laure Dardé
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  4. Bernard Bouteille
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  5. Michel Bonnivard
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  6. Pierre-Marie Preux
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  7. Hervé Gastinne
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  8. Philippe Vignon
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Corresponding author

Correspondence to Philippe Vignon.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-005-2806-y

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Normand, S., François, B., Dardé, ML. et al. Oral nystatin prophylaxis of Candida spp. colonization in ventilated critically ill patients. Intensive Care Med 31, 1508–1513 (2005). https://doi.org/10.1007/s00134-005-2807-x

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  • DOI: https://doi.org/10.1007/s00134-005-2807-x

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