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Fungemia and colonization with nystatin-resistant Candida rugosa in a burn unit
M P Dubé1, P N Heseltine, M G Rinaldi
1Department of Medicine, University of Southern California School of Medicine, Los Angeles.
Abstract:
Yeast isolates from burned patients were analyzed retrospectively for a 7-year period (1984-1991). Topical nystatin was used routinely in the burn wound dressing as antifungal therapy beginning in July 1986. Nystatin used was associated with a significant decrease in overall yeast acquisitions in burn wounds; yeasts were isolated from 15.5% of admitted patients before the use of nystatin vs. 10.5% with use of nystatin (odds ratio [OR] = 0.64; 95% confidence interval [CI], 0.48-0.86). New acquisitions of Candida rugosa in burn wounds increased from 0.36% of admissions during the period July 1984 to June 1986 (before nystatin use) to 5.25% in the period July 1986 to June 1991 (during use of nystatin) (OR = 15.3; 95% CI, 4.1-128). The incidence of fungemia decreased from 3.25% of admissions in the pre-nystatin period to 1.43% in the postnystatin period (OR = 0.43; 95% CI, 0.22-0.87). C. rugosa caused none of 18 fungemias in the former period and 15 of 21 in the latter period (P = .002). Susceptibility testing of recent C. rugosa isolates demonstrated resistance to nystatin and moderate susceptibility to amphotericin B and fluconazole. Topical nystatin use was associated with a decrease in fungemias and acquisition of yeasts in burn wounds but with an increase in colonization and fungemias caused by nystatin-resistant, amphotericin B-susceptible C. rugosa.
Insights
Topical nystatin use in burn wound patients reduced overall yeast acquisition and fungemia incidence. However, it led to an increase in nystatin-resistant Candida rugosa infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Burn Care
Background:
- Yeast infections are a concern in burn patients.
- Antifungal therapy is crucial for managing these infections.
Purpose of the Study:
- To evaluate the impact of topical nystatin on yeast acquisition and fungemia in burn patients.
- To assess changes in specific yeast species, particularly Candida rugosa, following nystatin implementation.
Main Methods:
- Retrospective analysis of yeast isolates from burn patients over a 7-year period (1984-1991).
- Comparison of yeast acquisition and fungemia rates before and after the routine use of topical nystatin.
- Antifungal susceptibility testing of isolated yeast strains.
Main Results:
- Topical nystatin use was associated with a significant decrease in overall yeast acquisition (15.5% vs. 10.5%) and fungemia incidence (3.25% vs. 1.43%).
- A significant increase in Candida rugosa acquisition (0.36% to 5.25%) and fungemia caused by this species was observed after nystatin implementation.
- Candida rugosa isolates showed resistance to nystatin but susceptibility to amphotericin B and fluconazole.
Conclusions:
- Topical nystatin effectively reduced overall yeast acquisition and fungemia in burn patients.
- Nystatin use selected for nystatin-resistant Candida rugosa, leading to increased colonization and fungemia caused by this specific pathogen.
- Alternative or combination antifungal strategies may be necessary to address nystatin-resistant yeast strains in burn wound infections.
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