Prophylactic oral nystatin for preterm babies under 33 weeks gestation decreases fungal colonisation and invasive fungaemia

Karthikeyan Ganesan ¹, Sundeep Harigopal ¹, Timothy Neal ² and Charles W Yoxall ^1*

¹ Liverpool Womens Hospital NHS Foundation Trust, United Kingdom
² The Royal Liverpool And Broadgreen University Hospitals NHS Trust, United Kingdom

^* To whom correspondence should be addressed. E-mail: bill.yoxall{at}lwh.nhs.uk.

Accepted 14 November 2008

Abstract

Background: Invasive fungal infection is an important cause of mortality and morbidity in extremely preterm babies. Colonization with Candida is a risk factor for systemic infection. We introduced a policy of oral nystatin prophylaxis in November 2000 aiming to reduce the incidence of invasive fungaemia.

Aim: The aim of this study was to determine whether this policy had reduced the rates of fungal colonization and invasive fungal infection.

Methods: All neonates < 33 weeks gestation born between 1998 and 2003 were studied. Neonates born between January 1998 and October 2000 who did not receive nystatin prophylaxis (Group A) were compared with those born between November 2000 and December 2003 who received nystatin prophylaxis (Group B). Demographic data, blood culture results and the results of weekly surface swabs were collected.

Results: 1459 neonates (Group A=724 , Group B=735) < 33 weeks gestation were admitted in the study period. There were no differences in birth weight, gestation, gender or proportion of babies transferred in from other units between the groups.

There was a reduction in colonization from 257 (35.5%) in Group A to 132 (18%) in Group B. The incidence of invasive fungaemia decreased from 30 (4.1%) to 13 (1.8%) between the two groups. There was also a reduction in mortality between the two groups from 17.8% to 11.8%.

Conclusions: The introduction of a prophylactic nystatin administration policy for babies born before 33 weeks was associated with a significant reduction in fungal colonisation and invasive fungal infection.