Fungemia and colonization with nystatin-resistant Candida rugosa in a burn unit.
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.
Dubé
M P
MP
Department of Medicine, University of Southern California School of Medicine, Los Angeles.
Heseltine
P N
PN
Rinaldi
M G
MG
Evans
S
S
Zawacki
B
B
D000666:Amphotericin B / Q000494:pharmacology; D002053:Burn Units; D002056:Burns / Q000382:microbiology*; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000382:microbiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000145:classification / Q000188:drug therapy / Q000382:microbiology*; D015725:Fluconazole / Q000494:pharmacology; D005437:Flucytosine / Q000494:pharmacology; D006801:Humans; D007654:Ketoconazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D009761:Nystatin / Q000494:pharmacology; D012189:Retrospective Studies
D009761:Nystatin; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine; D007654:Ketoconazole