[The clinical research of nystatin in prevention of invasive fungal infections in patients on mechanical ventilation in intensive care unit].

ABSTRACT

OBJECTIVE: To observe the effect of nystatin on incidence of invasive fungal infections (IFI) and the prognosis of mechanically ventilated critically ill patients. METHODS: A prospective study was conducted. Critical ill patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from May 1st, 2012 to April 30th, 2013 needing mechanical ventilation were enrolled. The patients were randomly divided into two groups by envelope method. Patients in the nystatin group were administered nystatin 1000 kU three times a day via the gastric tube; and patients in the control group were given gastrointestinal prokinetic drug as placebo. The specimens were collected every 3 days throughout the ICU stay (T0, T3, T6, T9), the strain distribution was observed, and the corrected colonization index (CCI) of all patients were calculated. The incidence of candidemia and 28-day mortality as well as the duration of stay in ICU and hospital were also recorded. RESULTS: A total of 874 strains were isolated from 124 patients, of which Candida albicans accounted for 57.6% (503/874). The most frequently colonized body sites were oropharyngeal site,account for 35.6% (311/874). The CCI of the nystatin group were lower than those of the control group at T6 and T9 [T6 0.19±0.10 vs. 0.39±0.15, T9 0.00 (0.10) vs. 0.45 (0.30), all P<0.05]. The incidence of candidemia in the nystatin group was slightly lower than that in control group [0.5% (3/60) vs. 7.8% (5/64), P>0.05]. The mortality in the nystatin group was lower than that in control group [18.3% (11/60) vs. 34.4% (22/64), P<0.05]. ICU day in the nystatin group was shorter than that in the control group (days 9.56±3.47 vs. 11.89±6.32, P<0.05). However,hospital day was similar in the two groups (days 18.35±7.42 vs. 20.58±8.77, P>0.05). CONCLUSIONS: Nystatin might reduce the colonization of Candida albicans and was associated with shorter ICU day.