e reported. Azoles are generally well tolerated, but side effects such http://www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html as hepatic dysfunction are possible. These risks, even if low, could be more difficult to accept in the setting of prophylaxis in critically ill patients. The third advantage of oral nystatin is its low cost, making this strategy potentially highly cost-effective.Nonabsorbable polyenes are integrated in most selective decontamination of the digestive tract regimens, and a recent meta-analysis showed that they significantly reduce fungal carriage and overall fungal infections, but without impact on fungemia [30]. This meta-analysis, however, included only two trials testing nystatin prophylaxis.

Moreover, the majority of selective decontamination of the digestive tract regimens included either concurrent systemic or topical antibacterial antibiotic prophylaxis in the treatment group, which might increase the risk of fungal infection in that group relative to the placebo group. A recent study investigated the effect of oral nystatin prophylaxis to prevent Candida species colonisation [16]. This trial, however, included both medical and surgical patients and excluded those patients who exhibited baseline Candida species colonisation. Since colonisation can be observed on admission to the ICU in almost 50% of patients [17,18], a considerable cohort of ICU population was excluded in this latter study, making these positive results not applicable to all ICU patients.The present trial showed that oral nystatin prophylaxis started on the day of admission is significantly effective in reducing heavy fungal colonisation, even in baseline colonised patients.

This finding was presumably related to the efficacy of oral nystatin to significantly reduce the proportion of positive gastrointestinal sites (for example, stomach and rectum), as shown in the treatment group. Accordingly, the CCI regularly decreased over time in patients receiving nystatin, whereas it tended to increase in controls. No adverse events developed during the study period, confirming that this polyene is a safe choice in the surgical ICU population. Interestingly, nystatin prophylaxis also reduces colonisation in the urinary tract, which is now advocated as the easier and simpler marker for heavily colonised patients [31].

A possible explanation could be that oral nystatin, by reducing gastrointestinal fungal carriage, can also help to control genital and perineal fungal colonisation, thus lowering the risk of retrograde access to the urinary tract, especially in the presence of indwelling bladder catheters. Moreover, oral nystatin increases costs only by �1.1/patient/day of treatment (data not shown).In the present study, almost 70% of included patients were colonised at admission. This was a surprising finding. While neurosurgical and abdominal surgery patients have several comorbidities AV-951 and risk factors (that is, long hospital stay, central venous catheter, parenteral nutrition, antibiotic therapy) that may predispos