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Antifungal prophylaxis to prevent neonatal candidiasis: a survey of perinatal physician practices

Lauren A Burwell1, David Kaufman, Jennifer Blakely

  • 1Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. lburwell@ph.lacounty.gov

Pediatrics
|September 20, 2006
PubMed

Insights

Antifungal prophylaxis is not widely used in very low birth weight infants despite preliminary evidence of fluconazole efficacy. Further studies are needed to address resistance and clarify prophylaxis criteria for preventing neonatal candidemia.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Neonatal candidemia, bloodstream infections caused by Candida species, carries a high mortality rate in very low birth weight (VLBW) infants.
  • Preliminary data suggest fluconazole prophylaxis may reduce Candida colonization and invasive infections in high-risk VLBW neonates.
  • The current extent of antifungal prophylaxis use for preventing neonatal candidemia is not well-documented.

Purpose of the Study:

  • To investigate the utilization patterns of antifungal prophylaxis in the care of very low birth weight infants.
  • To identify the agents, indications, and rationales behind current antifungal prophylaxis practices among clinicians.
  • To understand the perceived barriers to the widespread adoption of antifungal prophylaxis.

Main Methods:

  • A survey was distributed to a random sample of members from the American Academy of Pediatrics Section on Perinatal Pediatrics.
  • Data collected included information on prophylactic agents, indications for use, and the rationale for clinical practices.
  • Responses from clinicians providing care to VLBW infants were analyzed.

Main Results:

  • Of 219 respondents, 34% reported using antifungal prophylaxis.
  • Intravenous fluconazole was the most common agent (66%), followed by oral nystatin (59%) and intravenous amphotericin B (21%).
  • Concerns regarding antifungal resistance, unclear initiation criteria, and the role of surveillance cultures were more prevalent among non-users compared to fluconazole users.

Conclusions:

  • Despite preliminary evidence of fluconazole's efficacy, its use for preventing candidemia in VLBW infants is not widespread.
  • Further research is warranted to investigate the emergence of antifungal resistance.
  • Clarification of criteria for initiating prophylaxis, including the role of surveillance cultures, is needed.
Abstract

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