Topical nystatin prophylaxis: a likely viable measure for reducing impact of candidemia in neurosurgical patients with early tracheostomy intubation

topical antifungal prophylaxis [1-4]. For this reason we read with interest the paper published by Giglio and colleagues [5] underlining the ability of oral nystatin to reduce fungal colonization in surgical/trauma ICU patients. In our experience, we observed a dramatic increase of candidemia prevalence in neurosurgical ICU patients after implementation of early tracheostomy (from 2.2% to 9.7%). Following an analysis of data collected, we developed the idea that Candida colonization could spread by contiguity from the oropharynx to the trachea and the tracheostomy site. Th e proximity of the trache ostomy to the central venous catheter (CVC) insertion site could be considered a predisposing factor for the development of candidemia. Th erefore, we suggested topical nystatin prophylaxis in order to reduce the inci dence of candidemia. From an operative point of view, we have encouraged prophylactic interventions con sis ting of oral nystatin administration (500,000 IU) along with oral and tracheostomy site brushings four times a day. Th ese measures led to a statistically signifi cant reduction of candidemia during the fi rst 7 months of nystatin use: in detail, while 12 of 124 patients (9.7%) developed at least one laboratory confi rmed candidemia during the whole of 2011, no blood cultures were positive for Candida spp. in 59 patients admitted to the ICU during the period from January to July 2012 (P = 0.01; Figure 1).