Oral amphotericin B for the prevention of Candida bloodstream infection in critically ill children*

Ben‐Ari, Josef; Samra, Zmira; Nahum, Elhanan; Levy, I.; Ashkenazi, Shai; Schonfeld, Tommy

doi:10.1097/01.pcc.0000200946.30263.b6

Cited by 13 publications

(8 citation statements)

References 19 publications

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“…Our findings suggest that monitoring for Candida colonization may help in predicting subsequent infection with identical strains in critically ill children being treated in PICU for severe sepsis. This may offer an opportunity for interventions, such as prophylactic antifungal therapy, to prevent candidemia (33,34) and thus reduce the increased cost of ICU stay caused by opportunistic candidemia (35).…”

Section: Discussionmentioning

confidence: 99%

Candida colonization and candidemia in a pediatric intensive care unit

Singhi

Rao

Chakrabarti

2008

Pediatric Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Candida colonization and candidemia in a pediatric intensive care unit

Singhi

Rao

Chakrabarti

2008

Pediatric Critical Care Medicine

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“…A recently published study supports prophylactic use of oral amphotericin B for prevention of candida blood stream infections in ventilated patients in PICU. 94 However, prophylactic use is not without dangers and studies need to address concerns regarding emergence of drug resistance and long term safety of such policy.…”

Section: Preventionmentioning

confidence: 99%

Invasive candidiasis in pediatric intensive care units

Singhi

Deep

2009

Indian J Pediatr

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Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

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“…4, 5 Bacterial pathogens remain the predominant causative organisms in CA-BSI’s 1, 2 ; however fungal pathogens are significant contributors, especially in patients treated with broad-spectrum antibiotics. 6, 7 Candida species have been found to be the fifth most common cause of nosocomial infections 1, 5, 8, 9 and the third most common cause of CA-BSI. 10 …”

Section: Introductionmentioning

confidence: 99%

The morbidity and mortality of patients with fungal infections before and during extracorporeal membrane oxygenation support*

Pluim

Halasa

Phillips

et al. 2012

Pediatric Critical Care Medicine

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Objective To evaluate the prevalence of fungal infections (both pre- and post-cannulation) while on extracorporeal membrane oxygenation (ECMO) support and the associated morbidity and mortality. Design Retrospective cohort study. Patient and Methods The Extracorporeal Life Support Organization (ELSO) database is an international voluntary registry of clinical data for patients placed on ECMO. The database was queried for all patients on ECMO from 1997–2009. Patient and ECMO data collected included age, support type, length of support, infection status and organism code, discharge status, complications and component failures. Outcomes of interest were mortality, ECMO related patient complications, and mechanical component failures. Results From 1997–2009, there were 21,073 patient ECMO runs analyzed of which 12,933 were in the neonatal group (0–30 days), 6,073 were in the pediatric group (31 days-< 18 years old), and 2,067 were in the adult group (≥ 18 years). The prevalence of fungal infection during ECMO varied by age group and timing of infection and ranged from 0.04% to 5%. Fungal infections pre- and on-ECMO conferred a statistically significant higher relative risk of mortality for all age groups and varied by support type and timing of infection. ECMO related complications and component failures were not statistically significantly affected by infection status. Conclusions Fungal infection before or during ECMO increases the odds of mortality and the magnitude of this effect is dependent upon age-group and timing of infection. This increased mortality was not the result of increased patient or mechanical complications during ECMO. For patients with fungal infections pre-ECMO, 82–89% demonstrated presumed clearance during ECMO. Although the risk of mortality increased with fungal infections, it does not appear that fungal infection before or during ECMO is a contraindication to initiation or continuation of support.

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Oral amphotericin B for the prevention of Candida bloodstream infection in critically ill children*

Abstract: Prophylactic administration of oral amphotericin B may lead to a significant decrease in the rate of Candida bloodstream infection in ventilated pediatric intensive care unit patients.

Cited by 13 publications

References 19 publications

Candida colonization and candidemia in a pediatric intensive care unit

Candida colonization and candidemia in a pediatric intensive care unit

Invasive candidiasis in pediatric intensive care units

The morbidity and mortality of patients with fungal infections before and during extracorporeal membrane oxygenation support*

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