Laura Ferreras-Antolín1,2, Adam Irwin3,4, Ayad Atra5, Alicia Dermirjian6, Simon B Drysdale7, Marieke Emonts8,9, Paddy McMaster10, Stephane Paulus7,11, Sanjay Patel12, Sally Kinsey13, Stefania Vergnano14, Elisabeth Whittaker15, Adilia Warris1,3. 1. From the Medical Research Council Centre for Medical Mycology at the University of Aberdeen, Aberdeen Fungal Group, Institute of Medical Sciences, Aberdeen. 2. St George's University Hospitals NHS Foundation Trust. 3. Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom. 4. The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia. 5. Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton. 6. Department of Infectious Diseases and Immunology, Evelina Children Hospital, London. 7. Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. 8. Department of Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust. 9. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne. 10. Department of Paediatric Infectious Diseases, Royal Manchester Childrens´ Hospital, Manchester. 11. Institute of Infection and Global Health, University of Liverpool, Liverpool. 12. Department of Paediatric Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton. 13. Department of Paediatric Haematology and Oncology, Leeds General Infirmary, Leeds. 14. Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol. 15. Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom.
Abstract
BACKGROUND: Diagnostic challenges combined with the vulnerability of neonates to develop invasive candidiasis (IC) may lead to antifungal administration in the absence of IC. A modified point-prevalence study was performed to obtain an improved insight and understanding of antifungal prescribing in this specific patient population. METHODS: Neonates and infants ≤90 days of age receiving systemic antifungals from 12 centers in England were included. Data were collected prospectively during 26 consecutive weeks and entered into an online REDCap database. RESULTS: Two hundred eighty neonates and infants were included, the majority ≤1 month of age (68.2%). Prematurity was the commonest underlying condition (68.9%). Antifungals were prescribed for prophylactic reason in 79.6%; of those, 64.6% and 76.3% were extreme low birth weight infants and prematurely born neonates, respectively. Additional risk factors were present in almost all patients, but only 44.7% had ≥3 risk factors rendering them more susceptible to develop IC. Nonpremature and non extremely low birth weight premature infants only scored ≥3 risk factors in 32.6% and 15%, respectively. Fluconazole was the most common antifungal used (76.7% of all prescriptions), and commonly underdosed as treatment. The number of microbiologic proven IC was low, 5.4%. CONCLUSIONS: Neonatal antifungal prophylaxis is commonly prescribed outside the recommendations based on known risk profiles. Fluconazole is the main antifungal prescribed in neonates and infants, with underdosing frequently observed when prescribed for treatment. Number of proven IC was very low. These observations should be taken into consideration to develop a national pediatric Antifungal Stewardship program aiming to guide rational prescribing.
BACKGROUND: Diagnostic challenges combined with the vulnerability of neonates to develop invasive candidiasis (IC) may lead to antifungal administration in the absence of IC. A modified point-prevalence study was performed to obtain an improved insight and understanding of antifungal prescribing in this specific patient population. METHODS: Neonates and infants ≤90 days of age receiving systemic antifungals from 12 centers in England were included. Data were collected prospectively during 26 consecutive weeks and entered into an online REDCap database. RESULTS: Two hundred eighty neonates and infants were included, the majority ≤1 month of age (68.2%). Prematurity was the commonest underlying condition (68.9%). Antifungals were prescribed for prophylactic reason in 79.6%; of those, 64.6% and 76.3% were extreme low birth weight infants and prematurely born neonates, respectively. Additional risk factors were present in almost all patients, but only 44.7% had ≥3 risk factors rendering them more susceptible to develop IC. Nonpremature and non extremely low birth weight premature infants only scored ≥3 risk factors in 32.6% and 15%, respectively. Fluconazole was the most common antifungal used (76.7% of all prescriptions), and commonly underdosed as treatment. The number of microbiologic proven IC was low, 5.4%. CONCLUSIONS: Neonatal antifungal prophylaxis is commonly prescribed outside the recommendations based on known risk profiles. Fluconazole is the main antifungal prescribed in neonates and infants, with underdosing frequently observed when prescribed for treatment. Number of proven IC was very low. These observations should be taken into consideration to develop a national pediatric Antifungal Stewardship program aiming to guide rational prescribing.