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Changes in the incidence of candidiasis in neonatal intensive care units
Sofia Aliaga1, Reese H Clark, Matthew Laughon
1Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, North Carolina;
Objective:
Neonatal invasive candidiasis is associated with significant morbidity and mortality. We describe the association between invasive candidiasis and changes in use of antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotics over time.
Methods:
We examined data from 709,325 infants at 322 NICUs managed by the Pediatrix Medical Group from 1997 to 2010. We determined the cumulative incidence of invasive candidiasis and use of antifungal prophylaxis, broad-spectrum antibacterial antibiotics, and empirical antifungal therapy by year.
Results:
We identified 2063 (0.3%) infants with 2101 episodes of invasive candidiasis. Over the study period, the annual incidence of invasive candidiasis decreased from 3.6 episodes per 1000 patients to 1.4 episodes per 1000 patients among all infants, from 24.2 to 11.6 episodes per 1000 patients among infants with a birth weight of 750-999 g, and from 82.7 to 23.8 episodes per 1000 patients among infants with a birth weight <750 g. Fluconazole prophylaxis use increased among all infants with a birth weight <1000 g (or <1500 g), with the largest effect on birth weights <750 g, increasing from 3.8 per 1000 patients in 1997 to 110.6 per 1000 patients in 2010. The use of broad-spectrum antibacterial antibiotics decreased among all infants from 275.7 per 1000 patients in 1997 to 48.5 per 1000 patients in 2010. The use of empirical antifungal therapy increased over time from 4.0 per 1000 patients in 1997 to 11.5 per 1000 patients in 2010.
Conclusions:
The incidence of invasive candidiasis in the NICU decreased over the 14-year study period. Increased use of fluconazole prophylaxis and empirical antifungal therapy, along with decreased use of broad-spectrum antibacterial antibiotics, may have contributed to this observation.
Insights
Neonatal invasive candidiasis incidence decreased significantly in NICUs. This decline is linked to increased fluconazole use for prophylaxis and empirical therapy, alongside reduced broad-spectrum antibiotic use.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal invasive candidiasis presents substantial morbidity and mortality risks.
- Changes in antifungal and antibiotic prescribing practices may influence candidiasis rates.
Purpose of the Study:
- To investigate the association between invasive candidiasis incidence and evolving antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotic use.
- To analyze trends over a 14-year period in neonatal intensive care units (NICUs).
Main Methods:
- Retrospective analysis of data from 709,325 infants across 322 NICUs (1997-2010).
- Evaluation of cumulative incidence of invasive candidiasis.
- Assessment of yearly trends in antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotic utilization.
Main Results:
- Invasive candidiasis incidence decreased from 3.6 to 1.4 episodes per 1000 patients overall.
- Incidence reductions were notable in very low birth weight infants (<750g and 750-999g).
- Fluconazole prophylaxis use increased significantly (3.8 to 110.6 per 1000 patients for <750g birth weight), broad-spectrum antibiotic use decreased (275.7 to 48.5 per 1000 patients), and empirical antifungal therapy use rose (4.0 to 11.5 per 1000 patients).
Conclusions:
- The study observed a significant decrease in neonatal invasive candidiasis over 14 years.
- Increased use of fluconazole prophylaxis and empirical antifungal therapy, coupled with reduced broad-spectrum antibacterial antibiotic use, likely contributed to the declining incidence.
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