Fungemia and Colonization with Nystatin-Resistant Candida rugosa in a Burn Unit

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.

Candida rugosa Candidaemia in a Critically Ill Trauma Patient Successfully Treated with Amphotericin B

“…In vitro sensitivity reported 40.5% and 61.4% susceptibility to fluconazole and voriconazole respectively [1] . The occurrence of fatal breakthrough infection with C. rugosa in patients on amphotericin B is in contrast to observations of favourable susceptibility reports to amphotericin B, flucytosine and voriconazole [5]- [7] . In our experience, successful management was done with amphotericin B in the present case.…”

“…Resistance to nystatin was apparent in a study reporting 15 episodes of candidaemia due to C.rugosa following topical nystatin in a burn unit [7] . In vitro sensitivity reported 40.5% and 61.4% susceptibility to fluconazole and voriconazole respectively [1] .…”

Candida rugosa , an Emerging Fungal Pathogen with Resistance to Azoles: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program

“…Fungemia due to this species of Candida was unrecognized prior to 1985, when catheterrelated fungemia was reported in two different institutions in the United States (15,21). Subsequently, Dube et al (3) reported 15 episodes of candidemia due to C. rugosa in burn patients receiving topical nystatin treatment in a U.S. hospital. No obvious source of the infections was found; however, the isolates were shown to be resistant to nystatin and to have reduced susceptibility to both amphotericin B and fluconazole.…”

Molecular genotyping of Candida species with special respect to Candida (Torulopsis) glabrata strains by arbitrarily primed PCR

“…The reason for these concordant observations of widespread prevalent genotypes among epidemiologically unrelated yeast strains is still unknown. Redkar et al [32] described a type of C. rugosa isolates to be predominant in burn patients, consistent with the theory that pathogenic isolates of this yeast species have emerged and persisted because of extensive use of topical nystatin [33]. It is known that the prophylactic use of ketoconazole in neutropenic patients may result in the emergence of a higher prevalence of C. glabrata among surveillance cultures [5].…”