Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants

• Published in: European journal of pediatrics Vol. 172; no. 10; pp. 1321 - 1326
• Main Authors: Demirel, Gamze, Celik, Istemi Han, Erdeve, Omer, Saygan, Sibel, Dilmen, Ugur, Canpolat, Fuat Emre
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2013; Springer Nature B.V
• Subjects: Antifungal Agents - therapeutic use; Birth weight; Breastfeeding & lactation; Childrens health; Disease prevention; Enrollments; Feces - microbiology; Female; Fungal infections; Fungi - isolation & purification; Gestational age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - microbiology; Infant, Premature, Diseases - prevention & control; Infant, Very Low Birth Weight; Intubation; Male; Medicine; Medicine & Public Health; Mortality; Mycoses - microbiology; Mycoses - prevention & control; Neonatal care; Newborn babies; Nutrition; Nystatin - therapeutic use; Oral administration; Original Article; Parenteral nutrition; Pediatrics; Performance evaluation; Premature babies; Premature birth; Probiotics; Probiotics - therapeutic use; Prospective Studies; Saccharomyces - physiology; Saccharomyces boulardii; Sepsis; Skin - microbiology; Teaching hospitals; Treatment Outcome; Ankara Turkey; Turkey; Invasive fungal infection; Candidal colonization; Very low birth weight infants; Nystatin
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-013-2041-4

Aim This study aims to compare the efficacy of orally administered Saccharomyces boulardii versus nystatin in prevention of fungal colonization and invasive fungal infections in very low birth weight infants. Method A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤32 weeks and birth weight of ≤1,500 g. They were randomized into two groups, to receive S. boulardii or nystatin. Skin and stool cultures were performed for colonization and blood cultures for invasive infections, weekly. Results A total of 181 infants were enrolled ( S. boulardii group, n  = 91; nystatin group, n  = 90). Fungal colonization of the skin (15.4 vs 18.9 %, p  = 0.532) and the stool (32.2 vs 27 %, p  = 0.441) were not different between the probiotic and nystatin groups. Two patients had Candida -positive blood culture in the nystatin group whereas none in the probiotic group. Feeding intolerance, clinical sepsis, and number of sepsis attacks were significantly lower in the probiotics group than in the nystatin group. Conclusion Prophylactic S. boulardii supplementation is as effective as nystatin in reducing fungal colonization and invasive fungal infection, more effective in reducing the incidence of clinical sepsis and number of sepsis attacks and has favorable effect on feeding intolerance.