Role of oral nystatin prophylaxis in cardiac surgery with prolongedextracorporeal circulation

Abstract

Duration >120 minutes of extracorporeal circulation (ECC) during cardiopulmonary bypass procedure was associated to an increased risk of candidemia in the intensive care unit (ICU). To evaluate oral nystatin prophylaxis in cardiac surgery considering its exclusive effect on Candida, in the absence of systemic effects and selection of resistant strains to polyene. We conducted an observational study in the postcardiac surgery ICU of Policlinico "Umberto I" of Rome. From January 2014, all patients with a prolonged ECC >120 minutes were systematically treated with oral nystatin (Prophylaxis group). This group was compared with all patients hospitalised in the same ICU, who have not received oral nystatin after ECC >120 minutes (No prophylaxis group). Overall, 672 consecutive patients were analyzed: 318 (47.3%) patients belonged to the no prophylaxis group, and 354 (52.7%) patients to the prophylaxis group. Diagnosis of candidemia was confirmed in 7 (2.2%) patients, all belonged to the no prophylaxis group. At multivariate analysis, oral nystatin prophylaxis showed a protective effect for development of candidemia after cardiac surgery. Oral nystatin prophylaxis, in patients who underwent a ECC >120 minutes, seems to reduce development of candidemia; however, the real efficacy of such prophylaxis approach requires further investigation.

Relationship between oral candidiasis and users of dental prostheses

“…Some people said they felt discomfort from the use of the prosthesis, others reported maladaptation, besides showing cracks and blemishes. Such facts were observed by other authors [7][8][9]14 who recommended a periodic visit to the dental surgeon to evaluate the adaptation, hygiene of the prostheses and the need to replace them.…”

“…Maladaptive prosthetics with cracks or spots are considered irritating factors for the buccal mucosa and may cause several lesions such as prosthetic stomatitis, inflammatory fibrous hyperplasia, inflammatory papillary hyperplasia, angular cheilitis and traumatic ulceration and cadidiasis 14 .…”

“…The measures adopted were as follows: Prescription Nystatin oral suspension (Micostatin® 100,000 IU / ml) -Blood for 1 minute and swallow 5 ml, 4 times daily for 7 to 15 days until lesion remission; oral hygiene instruction; guidance on the chemical disinfection of prostheses with water solution and sodium hypochlorite (0.25%), in the proportion of 1 ml to 10 ml of drinking water, for half an hour, twice a week, at least; suggestion for nocturnal resting of the prostheses and making new prostheses if necessary. In the removable partial dentures, the hygiene was performed with neutral soap, dental brush, and placed in a glass with water during sleep 14 .…”

“…The fungus responsible for this disease is of the genus Candida, and there are several types of the same species, for example: C. tropicalis, C. glabrata, C. krusei and C. albicans. However, the species C. albicans is the most present and pathogenic of all species of the genus Candida [1][2][3][4] .…”

“…The use of dental prosthesis associated with poor hygiene, both buccal and prosthesis, are also important local etiological factors 4 . People who use removable prostheses are more likely to have candidiasis compared to individuals who do not use them because of the ease of adhesion of microorganisms to acrylic prostheses, leading to the development of infection 6 .…”