Abstract
Background: The intensive care unit (ICU) is a treatment room exposed to nosocomial infections. Mechanical ventilation support is often required by 10%-20% of patients admitted to the ICU, where there is a risk of candidemia occurrence. Candidemia is a disease that occurs in any patient at a health care facility, where Candida species are found in blood culture specimens processed at laboratories. Candida species are some of the most common species causing bloodstream infections in nonneutropenic patients treated in the ICU and are responsible for 8%-12% of cases. Antifungal prophylaxis is often used in ICU for patients prone to candidemia using the Candida score, which includes parameters such as Candida colonization, history of surgery, severe sepsis, and total parenteral nutrition. Nystatin is considered a prophylactic antifungal in the ICU to reduce the incidence of candidemia and the morbidity and mortality of patients in the ICU.
Methods: This was a randomized clinical trial conducted using a double-blind method. After approval by the Faculty of Medicine Ethics Committee, Universitas Sumatera Utara, Medan, 40 research samples were collected, which were randomly divided into two groups after verifying the inclusion criteria. Groups A and B received 100,000 IU nystatin and 0.9% NaCl, respectively. The obtained research data were tested using a Statistical Package for the Social Sciences (SPSS).
Results: Positive blood culture results were fewer in the nystatin group than in the 0.9% NaCl group (3 vs. 4). Additionally, positive tracheal aspirate culture results were fewer in the nystatin group than in the 0.9% NaCl group (0 vs. 1). The largest distribution of Candida in blood culture was Candida tropicalis, whereas only one species of Candida glabrata was found in tracheal aspirate culture. The 7th-day mortality in the nystatin group was lower than that in the 0.9% NaCl group (11 vs. 14).
Conclusion: Nystatin effectively reduced the incidence of candidemia, which was lower in the nystatin group than in the 0.9% NaCl group. Moreover, tracheal aspirate culture results in the nystatin group were better than those in the 0.9% NaCl group. Furthermore, the 7th-day mortality rate in the nystatin group was lower than that of the 0.9% NaCl group. The most distributed Candida species in the blood culture was Candida tropicalis, whereas only one species, Candida glabrata, was found in the tracheal aspirate culture.
Felix Chandra, Andriamuri Primaputra Lubis,Yutu Solihat, Juliandi Harahap
