When to Suspect Fungal Infection in Neonates: A Clinical Comparison of<i>Candida albicans</i>and<i>Candida parapsilosis</i>Fungemia With Coagulase-Negative Staphylococcal Bacteremia

Benjamin, Daniel K.; Ross, Kelly; McKinney, Ross E.; Auten, Richard L.; Fisher, Randall G.

doi:10.1542/peds.106.4.712

Cited by 189 publications

(122 citation statements)

References 22 publications

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“…1 Besides gestational age and birth weight, neonates in the intensive care unit are at higher risk for developing infection because of their immature immune systems, gastrointestinal pathology, exposure to H2 blockers (famotidine, ranitidine), long term use of central vascular catheters, use of total parenteral nutrition (TPN), use of third-generation cephalosporins and need for mechanical ventilation. [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.…”

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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“…Early antibiotic treatment may prevent clinical deterioration if the cause for leukocytosis is sepsis, but uncontrolled antibiotic use could lead to increased bacterial resistance and predisposes infants to fungal infections. 17,18 Our primary objective was to identify clinical factors associated with leukocytosis and to compare neonatal morbidity and mortality among VLBW infants with or without leukocytosis.…”

Section: Introductionmentioning

confidence: 99%

Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes

et al. 2008

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Objective: Primary objective was to identify clinical factors and outcomes associated with leukocytosis in very low birth weight (VLBW) neonates. Secondary objective was to compare outcomes between infants with earlyonset (p72 h of age) and late-onset leukocytosis (>72 h).Study Design: A retrospective matched cohort study of VLBW neonates born at p30 weeks of gestation identified with a white blood cell count of X40 000 was undertaken. Matched infants had no leukocytosis and were of similar gestational age. Data on common neonatal morbidities were collected from charts.Result: Leukocytosis was identified in 96 infants giving an incidence rate of 6.1%. Of all, 94 matched infants without leukocytosis were identified. There were no differences in the demographic features and risk factors between the two groups. The incidence of confirmed infection among infants with leukocytosis was 22%. No differences in common neonatal morbidities and mortality were identified between two groups. Late-onset leukocytosis (X72 h of age) was associated with sepsis and necrotizing enterocolitis. No differences in any of the other outcomes between earlyonset and late-onset leukocytosis were identified.Conclusion: Leukocytosis, especially late onset, was associated with infection in VLBW infants. Late-onset leukocytosis was also associated with necrotizing enterocolitis indicating that postnatal age at time of leukocytosis should be considered when formulating clinical decisions.

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“…5 Since Candida has a propensity for deep tissue invasion, severe morbidities, including meningoencephalitis, endophthalmitis, osteomyelitis, and endocarditis, are not uncommon. Mortality from disseminated fungal infection is approximately 20 to 30% in NICU and PICU patients, [6][7][8] but may increase to greater than 50% if treatment is delayed. 2,9,10 Early detection of fungal sepsis and institution of appropriate therapy has been shown to improve patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Detection of Fungemia by Polymerase Chain Reaction in Critically Ill Neonates and Children

et al. 2003

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OBJECTIVE:To compare polymerase chain reaction (PCR) with blood culture for the detection of fungemia in neonatal and pediatric intensive care unit patients. STUDY DESIGN:A total of 0.2 to 0.5 ml of blood was collected simultaneously with blood culture in patients with suspected sepsis. Following DNA extraction, the gene for fungal 18S rRNA was amplified and PCR products analyzed by agarose gel electrophoresis. RESULTS:Of 70 patient samples, nine of nine with a positive blood culture for Candida were PCR positive, and one of four with a positive blood culture for Malassezia was PCR positive. In total, 13 of 57 samples with negative blood culture for fungus were PCR positive. Seven of these 13 patients had other evidence of invasive fungal disease. In contrast, none of the 44 blood culture-negative/PCR-negative patients had other evidence of fungal infection. CONCLUSIONS:PCR may be a useful adjunct to blood culture for the rapid detection of fungemia in high-risk patients.

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When to Suspect Fungal Infection in Neonates: A Clinical Comparison ofCandida albicansandCandida parapsilosisFungemia With Coagulase-Negative Staphylococcal Bacteremia

Cited by 189 publications

References 22 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

Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes

Detection of Fungemia by Polymerase Chain Reaction in Critically Ill Neonates and Children

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