David A Kaufman1. 1. Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA. dak4r@virginia.edu
Abstract
PURPOSE OF REVIEW: Owing to the high mortality, risk of neurodevelopmental impairment and end-organ involvement with fungal infections in the neonate, prevention of invasive Candida infections in extremely preterm infants should be a priority for each neonatal ICU. RECENT FINDINGS: Even with prompt or empiric treatment, mortality and neurodevelopmental impairment is high (57%) in infants <1000 g. Multiple studies have been performed with fluconazole prophylaxis, including a recent multicenter randomized controlled trial. All of the studies have demonstrated efficacy and safety with no increase or emergence of fungal resistance. Analysis of these studies demonstrates that fluconazole prophylaxis decreased the incidence of invasive Candida infections in high-risk infants <1000 g by 91% (P = 0.0004) and all infants <1500 g by 85% (P < 0.0001). The mortality rate from all causes was 25% lower (P = 0.029). Furthermore, studies have demonstrated that all Candida-related mortality can be eliminated in an entire neonatal ICU by targeting fluconazole prophylaxis in infants <1000 g. SUMMARY: Targeting fluconazole prophylaxis to infants who are either <1000 g or < or =27 weeks is highly effective, safe and inexpensive, and can eliminate these infections as a cause of neurodevelopmental impairment and mortality.
PURPOSE OF REVIEW: Owing to the high mortality, risk of neurodevelopmental impairment and end-organ involvement with fungal infections in the neonate, prevention of invasive Candida infections in extremely preterm infants should be a priority for each neonatal ICU. RECENT FINDINGS: Even with prompt or empiric treatment, mortality and neurodevelopmental impairment is high (57%) in infants <1000 g. Multiple studies have been performed with fluconazole prophylaxis, including a recent multicenter randomized controlled trial. All of the studies have demonstrated efficacy and safety with no increase or emergence of fungal resistance. Analysis of these studies demonstrates that fluconazole prophylaxis decreased the incidence of invasive Candida infections in high-risk infants <1000 g by 91% (P = 0.0004) and all infants <1500 g by 85% (P < 0.0001). The mortality rate from all causes was 25% lower (P = 0.029). Furthermore, studies have demonstrated that all Candida-related mortality can be eliminated in an entire neonatal ICU by targeting fluconazole prophylaxis in infants <1000 g. SUMMARY: Targeting fluconazole prophylaxis to infants who are either <1000 g or < or =27 weeks is highly effective, safe and inexpensive, and can eliminate these infections as a cause of neurodevelopmental impairment and mortality.
Authors: Angela Ahlquist Cleveland; Monica M Farley; Lee H Harrison; Betsy Stein; Rosemary Hollick; Shawn R Lockhart; Shelley S Magill; Gordana Derado; Benjamin J Park; Tom M Chiller Journal: Clin Infect Dis Date: 2012-08-14 Impact factor: 9.079
Authors: Anna C Seale; Hannah Blencowe; Anita Zaidi; Hammad Ganatra; Sana Syed; Cyril Engmann; Charles R Newton; Stefania Vergnano; Barbara J Stoll; Simon N Cousens; Joy E Lawn Journal: Pediatr Res Date: 2013-12 Impact factor: 3.756
Authors: Sofia Aliaga; Reese H Clark; Matthew Laughon; Thomas J Walsh; William W Hope; Daniel K Benjamin; David Kaufman; Antonio Arrieta; Daniel K Benjamin; P Brian Smith Journal: Pediatrics Date: 2014-01-20 Impact factor: 9.703