Oral nystatin as antifungal prophylaxis in critically ill patients: an old SDD tool to be renewed?

Excerpt

Invasive candidiasis remains a dreadful complication in hospitalized patients, generally associated with poor prognosis [1, 2]. Except in the case of candidemia, it is difficult to diagnose. In contrast to Aspergillus spp., biological tools have not been developed to diagnose candidiasis [3], and using the current clinical and microbiological criteria the threshold between colonization and infection may be difficult to distinguish [4]. Risk factors including colonization predispose to the development of invasive candidiasis in both immunocompromised and nonimmunocompromised patients [5, 6, 7]. However, as a majority of them are directly linked to an underlying disease or its treatments, it is almost impossible to target them for prevention. The high proportion of bone marrow transplant recipients developing candidiasis has stimulated clinical research which has established the value of antifungal prophylaxis. Azole-based prophylaxis has progressively imposed as a standard of care for severely neutropenic patients [8] and in most solid-organ transplant recipients [9]. However, antifungal prophylaxis has been repeatedly implicated in the increasing proportion of non-albicans Candida isolated in many cancer centers [10, 11]. This has generated a considerable debate, and guidelines have been modified accordingly [12]. …