Giglio Mariateresa, Caggiano Giuseppina, Dalfino Lidia, Brienza Nicola, Alicino Ilaria, Sgobio Aurelia, Favale Antonella, Coretti Caterina, Montagna Maria Teresa, Bruno Francesco, Puntillo Filomena
Anaesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, Bari 70124, Italy.
Crit Care. 2012 Dec 12;16(2):R57. doi: 10.1186/cc11300.
Candida prophylaxis in ICU is still a matter of debate. Oral chemoprophylaxis has been advocated to reduce the incidence of Candida colonisation and infection.
We performed a randomised trial studying a single drug (nystatin) versus control in surgical/trauma ICU patients. Multiple-site testing for fungi was performed in each patient on ICU admission (T0) and subsequently every 3 days (T3, T6, T9, and so forth). The primary evaluation criterion was the time course of the corrected colonisation index.
Ninety-nine patients were enrolled. At admission, 69 patients exhibited Candida colonisation: the most frequently colonised body sites were the stomach and the pharynx. The most frequent isolated species was Candida albicans. The corrected colonisation index was similar in the two groups at T0 (P = 0.36), while a significant statistical difference was observed between the treatment and control groups at T6 (median 0.14 and 0.33, respectively; P = 0.0016), at T9 (median 0.00 and 0.28, respectively; P = 0.0001), at T12 (median 0.00 and 0.41, respectively; P = 0.0008), and at T15 (median 0.00 and 0.42, respectively; P < 0.0003). The same results were obtained in the subgroup of patients already colonised at ICU admission.
This trial shows that nystatin prophylaxis significantly reduces fungal colonisation in surgical/trauma ICU patients, even if already colonised.
ClinicalTrials.gov: NCT01495039.
重症监护病房（ICU）中念珠菌的预防仍然存在争议。口服化学预防措施已被提倡用于降低念珠菌定植和感染的发生率。
我们进行了一项随机试验，研究单一药物（制霉菌素）与对照组在外科/创伤ICU患者中的效果。在每位患者入住ICU时（T0）以及随后每3天（T3、T6、T9等）进行多点真菌检测。主要评估标准是校正定植指数的时间进程。
共纳入99例患者。入院时，69例患者出现念珠菌定植：最常定植的身体部位是胃和咽部。最常分离出的菌种是白色念珠菌。两组在T0时校正定植指数相似（P = 0.36），而在T6（中位数分别为0.14和0.33；P = 0.0016）、T9（中位数分别为0.00和0.28；P = 0.0001）、T12（中位数分别为0.00和0.41；P = 0.0008）和T15（中位数分别为0.00和0.42；P < 0.0003）时，治疗组和对照组之间观察到显著的统计学差异。在ICU入院时已定植的患者亚组中也获得了相同的结果。
该试验表明，制霉菌素预防可显著降低外科/创伤ICU患者的真菌定植，即使患者已经定植。
ClinicalTrials.gov：NCT01495039。
