Micafungin versus fluconazole for prophylaxis against fungal infections in premature infants

Maede, Yoshinobu; Ibara, Satoshi; Nagasaki, Hiraku; Inoue, Takeshi; Tokuhisa, Takuya; Torikai, Motofumi; Ishihara, Chie; Matsui, Tatsunosuke; Kodaira, Yuichi

doi:10.1111/ped.12157

Cited by 10 publications

(4 citation statements)

References 25 publications

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“…This recommendation is due to the prevalent fluconazole resistance of C. auris [ 21 , 34 ]. A small comparative clinical study reported that micafungin compared to fluconazole prophylaxis against fungal infections in extremely low-birthweight infants was associated with a decreased incidence of C. albicans infections [ 146 ]. Additionally, safety and pharmacokinetics of micafungin were previously assessed in very low birthweight infants [ 147 , 148 , 149 ].…”

Section: C Auris Antifungal Resistance and Therapeutic Optionsmentioning

confidence: 99%

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

Ashkenazi‐Hoffnung

Danziger

2023

JoF

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During the past decade, Candida auris emerged across the world, causing nosocomial outbreaks in both pediatric and adult populations, particularly in intensive care settings. We reviewed the epidemiological trends and the clinical and microbiological characteristics of C. auris infection, focusing on the pediatric population. The review is based on 22 studies, which included about 250 pediatric patients with C. auris infection, across multiple countries; neonates and premature babies were the predominant pediatric patient group affected. The most common type of infection reported was bloodstream infection, which was associated with exceptionally high mortality rates. Antifungal treatment varied widely between the patients; this signifies a serious knowledge gap that should be addressed in future research. Advances in molecular diagnostic methods for rapid and accurate identification and for detection of resistance may prove especially valuable in future outbreak situations, as well as the development of investigational antifungals. However, the new reality of a highly resistant and difficult-to-treat pathogen calls for preparedness of all aspects of patient care. This spans from laboratory readiness, to raising awareness among epidemiologists and clinicians for global collaborative efforts to improve patient care and limit the spread of C. auris.

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Section: C Auris Antifungal Resistance and Therapeutic Optionsmentioning

confidence: 99%

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

Ashkenazi‐Hoffnung

Danziger

2023

JoF

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“…Comparison of single dose pharmacokinetic studies in adult, paediatric, and infant patient populations reported micafungin clearance in premature infants >1000 g to be much higher compared to older children and adults. Micafungin has been used in premature infants for prophylaxis against C. albicans and was found to be superior to fluconazole 12–14 . Our protocol for prophylaxis was to administer micafungin at a dose of 3 mg/kg/day intravenously daily for infants under 32 weeks of gestation as had been reported 14 .…”

Section: Resultsmentioning

confidence: 99%

“…Micafungin has been used in premature infants for prophylaxis against C. albicans and was found to be superior to fluconazole. [12][13][14] Our protocol for prophylaxis was to administer micafungin at a dose of 3 mg/kg/day intravenously daily for infants under 32 weeks of gestation as had been reported. 14 This was given for the first 2 weeks after birth or longer till central lines were removed.…”

Section: Prevention Strategiesmentioning

confidence: 99%

Neonatal Candida auris infection: Management and prevention strategies – A single centre experience

Chandramati

Sadanandan

Kumar

et al. 2020

J Paediatrics Child Health

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Aim: Our aim was to identify the clinical features and outcome of multidrug resistant Candida auris (CA) infection in neonates. Methods: This is a retrospective case cohort study of 17 neonates who developed sepsis caused by CA infection in a tertiary care neonatal intensive care unit over 3 years. The risk factors, clinical features, treatment and outcome were studied. Results: The mean gestation was 32.4 AE 4.9 weeks with overall mortality of 41%. Clinical features were indistinguishable from other causes of sepsis. CA was sensitive to micafungin but resistant to fluconazole and had variable sensitivity to voriconazole and amphotericin. Survival improved to 83% when infants were treated with a combination of micafungin and amphotericin. Non-survivors were of lower birthweights and had other risk factors. Conclusions: The management guidelines and infection control measures are described in this largest series of neonatal CA infection. Treatment with a combination of amphotericin and micafungin improved the outcome.

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“…This suggestion comes as a result of the high resistance that C. auris momentarily presents to fluconazole [ 32 , 87 ]. A small, comparative clinical study reported that the use of micafungin, in comparison to fluconazole, for prophylaxis against fungal infections in ELBW neonates was connected with lower rates of C. albicans infection [ 88 ]. Furthermore, the safety and pharmacokinetics of micafungin have been evaluated in VLBW [ 89 , 90 ].…”

Section: Discussionmentioning

confidence: 99%

Candida auris Infection, a Rapidly Emerging Threat in the Neonatal Intensive Care Units: A Systematic Review

Sokou,

Palioura,

Kopanou Taliaka

et al. 2024

JCM

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(1) Background: In recent years, a global epidemiological shift in candidemia has been observed, marked by the emergence of resistant non-albicans Candida species. Candida auris, in particular, has become a significant global concern, causing infections in both pediatric and adult populations within healthcare settings. Despite its widespread impact, there is a limited understanding of the clinical course and transmission dynamics of neonatal systemic Candida auris infections, hindering effective prevention and management. This study focused on the epidemiologic data, the clinical presentation, risk factors, and outcome of C. auris infection in neonatal population. (2) Methods: A systematic review of the literature using PubMed and Scopus databases until December 2023 was conducted. (3) Results: A total of 24 relevant studies were identified, encompassing 476 documented cases of Candida auris infection in neonates. Prematurity emerged as a primary risk factor, alongside total parenteral nutrition, central line insertion, mechanical ventilation, and prior broad-spectrum antibiotic use. The mortality rate reached approximately 42%, with therapeutic details sparingly reported in 12% of cases. Treatment strategies varied, with amphotericin B predominantly used as monotherapy, while combination antifungal agents were used in 44% of cases. Notably, 97.4% of cases exhibited fluconazole resistance, and 67.1% showed resistance to amphotericin B. Limited data were available on resistance to other antifungal agents. (4) Conclusions: Despite the rarity of neonatal Candida auris infections, their global occurrence necessitates comprehensive preparedness in patient care. A deeper understanding of Candida auris pathogenesis is crucial for developing effective strategies to control and prevent neonatal infections caused by this pathogen.

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Micafungin versus fluconazole for prophylaxis against fungal infections in premature infants

Abstract: MCFG was superior to FLCZ as prophylaxis against fungal infections in extremely low-birthweight infants.

Cited by 10 publications

References 25 publications

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

Neonatal Candida auris infection: Management and prevention strategies – A single centre experience

Candida auris Infection, a Rapidly Emerging Threat in the Neonatal Intensive Care Units: A Systematic Review

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