Patterns of Fungal Colonization in Very Low Birth-Weight (Vlbw) Infants

Baley, Jill E.; Kliegman, Robert M.; Boxerbaum, Bernard; Fanaroff, A.A.

doi:10.1203/00006450-198404001-01054

Cited by 73 publications

(132 citation statements)

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“…[2][3][4] Early colonization of the skin and mucous membranes with Candida species can progress to candidemia in up to 60% of ELBW infants. [5][6][7] In addition to mortality, neonatal candidemia has been associated with increased NICU lengths of stay and hospital costs. 8 Kaufman et al 7 published the only prospective, randomized, double-blind clinical trial to date that demonstrates effectiveness and safety of fluconazole administration in preventing fungal colonization and invasive fungal infection in ELBW infants during the first 6 weeks of life.…”

Section: Introductionmentioning

confidence: 99%

Fluconazole prophylaxis for prevention of invasive fungal infections in targeted highest risk preterm infants limits drug exposure

et al. 2008

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Objective: Previous reports suggest a benefit of fluconazole prophylaxis in extremely low birth weight (ELBW) infants <1000 g. Our aim was to evaluate if limiting fluconazole prophylaxis to targeted highest risk infants effectively prevents invasive fungal infections, has no undesired side effects and limits unnecessary drug exposure.Study Design: This nonrandomized retrospective pre-post intervention study compared two groups of infants: (1) Infants <26 weeks gestation and/or <750 g birth weight, requiring central vascular access and admitted to the Monroe Carell Jr Children's Hospital at Vanderbilt neonatal intensive care unit (NICU) prior to 5 days of age, who received fluconazole prophylaxis and (2) a matched control group from the year prior to prophylaxis. This target population was selected for fluconazole prophylaxis based on prior infection control data from our institution and a number needed to treat of <15 to prevent one episode of fungemia. Following implementation and integration through the institution's computerized physician order entry (CPOE) system, provider adherence to the protocol was assessed during the prophylaxis period.Result: A total of 86 patients were included in the study, 44 in the no-prophylaxis group and 42 in the prophylaxis group. In the targeted prophylaxis group, no invasive fungal infections were observed as compared to nine infants with invasive infections in the no-prophylaxis group (P ¼ 0.004). No significant adverse effects were recorded. Targeting the highest risk infants reduced the number of infants <1000 g requiring prophylaxis from 80 to 42 (48% reduction) with no preventable infection missed. Provider compliance was 91% following implementation of this protocol through the CPOE system using a standardized order set. Conclusion:Targeting the highest risk infants for fluconazole prophylaxis through CPOE can effectively prevent invasive fungal infections and limit drug exposure with no unwanted side effects.

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Section: Introductionmentioning

confidence: 99%

Fluconazole prophylaxis for prevention of invasive fungal infections in targeted highest risk preterm infants limits drug exposure

et al. 2008

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“…Baley et al (2) observed that 26.7% of low birth weight newborns were colonized by Candida and 7.7% developed invasive disease. Low hemoculture positivity for fungi is an important obstacle to fungemia diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Candida species in umbilical catheters implanted in newborns in Natal, Brazil

Fernandes¹,

Júnior²,

Oliveira³

et al. 2007

Braz. J. Microbiol.

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All the newborns with umbilical venous catheters, hospitalized in the neonatal intensive care unit at Januário Cicco Maternity Hospital in Natal, Brazil, between January, 2003 and December, 2004 were studied. The prevalence of Candida species in the tips of intra-venous catheters was assessed, as well as the coexisting exposures that the patients were subjected to. Catheter tips were cultivated in blood agar and when yeast culture occurred, the colony was subcultivated for species identification through morphologic and biochemical assays. From a total of 240 catheters, 41 were positive for yeasts, and 34 were submitted to identification. The following agents were isolated: 13 C. albicans (38%), 10 Candida parapsilosis (29%), 8 C. tropicalis (20%), one C. guilliermondii (3%), one C. famata (3%) and one Trichosporon spp. (3%). Three patients among those with positive catheter tip fungal cultures were also hemoculture positive, with the same fungal species at both sites. Among the coexisting exposures, it should be pointed out that all the patients underwent broad spectrum antibiotic therapy, used a nasogastric probe, in addition to undergoing other invasive procedures such as mechanical ventilation and umbilical catheter implantation.

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“…El porcentaje de RNpret extremos colonizados que presentan una CI varía entre 7 y 28% en diferentes series 16,17 . Manzoni y cols., comunicaron una tasa de progresión a CI de 27,5%, en los pacientes colonizados por Candida spp en tres o más sitios versus 7,2% en aquellos RNpret extremos no colonizados (p < 0,001).…”

Section: Infectología Al Díaunclassified

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

Izquierdo

Santolaya

2014

Rev. chil. infectol.

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Patterns of Fungal Colonization in Very Low Birth-Weight (Vlbw) Infants

Cited by 73 publications

References 0 publications

Fluconazole prophylaxis for prevention of invasive fungal infections in targeted highest risk preterm infants limits drug exposure

Fluconazole prophylaxis for prevention of invasive fungal infections in targeted highest risk preterm infants limits drug exposure

Prevalence of Candida species in umbilical catheters implanted in newborns in Natal, Brazil

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

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