Oral Nystatin Prophylaxis for the Prevention of Fungal Colonization in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abdulrahman Al-Matary 1, Lina Almahmoud 2, Raneem Masmoum 3, Sultan Alenezi 4, Salem Aldhafiri 4, Abdullah Almutairi 5, Hussain Alatram 6, Athbi Alenzi 6, Mohammed Alajm 7, Ali Artam Alajmi 7, Hadil Alkahmous 8, Fulwah A Alangari 3, Abdulrahman AlAnzi 9, Salihah Ghazwani 10, Ahmed Abu-Zaid 11

Affiliations

24 August 2022

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doi: 10.7759/cureus.28345

Abstract

We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the prophylactic role of oral nystatin in the prevention of fungal colonization in very low birth weight (VLBW) infants compared with placebo or no treatment intervention. From inception until June 2022, we screened four major databases for pertinent RCTs and examined their risk of bias. The main outcomes were the rate of fungal colonization, rate of invasive fungal infection, rate of mortality, mean length of stay in the neonatal intensive care unit (NICU), and mean duration of antibiotic treatment. We summarized data as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI), using the fixed-effects model. Five RCTs met our inclusion criteria. One RCT was evaluated as having "high risk," one RCT was evaluated as having "some concerns," and three RCTs were evaluated as having "low risk" of bias. Compared with the control group, oral nystatin prophylaxis was correlated with substantial decrease in the frequency of fungal colonization (n=4 RCTs, RR=0.34, 95% CI {0.24, 0.48}, p<0.0001), the rate of invasive fungal infection (n=4 RCTs, RR=0.15, 95% CI {0.12, 0.19}, p<0.0001), and the mean duration of antibiotic treatment (n=3 RCTs, MD=-2.79 days, 95% CI {-5.01, -0.56}, p=0.01). However, there was no significant difference between both groups regarding the rate of mortality (n=4 RCTs, RR=0.87, 95% CI {0.64, 1.18}, p=0.37) and mean length of stay in NICU (n=3 RCTs, MD=-2.85 days, 95% CI {-6.52, 0.82}, p=0.13). In conclusion, among VLBW infants, the prophylactic use of oral nystatin was correlated with favorable antifungal benefits compared with placebo or no treatment intervention.

Keywords: fungal colonization; fungal infection; low birth weight; meta-analysis; nystatin.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of literature search. CENTRAL: Cochrane Central Register of Controlled Trials

Figure 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of literature search. CENTRAL: Cochrane Central Register of Controlled Trials

Figure 2. Summary of the risk of bias of the included randomized controlled trials.

Figure 2. Summary of the risk of bias of the included randomized controlled trials.

Figure 3. Meta-analysis of the rate of fungal colonization.

Figure 3. Meta-analysis of the rate of fungal colonization.

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