Infectious Diseases in Children Nosocomial Infections

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Nosocomial Infections

Neonatalogists differ on antifungal prophylaxis practices

Survey respondents call for more guidance on using prophylaxis in

very low birth weight infants.

by Colleen Zacharyczuk

Managing Editor

http://www.idinchildren.com/200506/frameset.asp?

article=antifungal.asp

June 2005

WASHINGTON — Antifungal prophylaxis to prevent candidemia was only

used by one-third of neonatologists who responded to a recent

survey.

The survey results, presented in an abstract here at the Pediatric

Academic Societies meeting, underscore the need for clinical

criteria to identify high-risk infants who may benefit from

prophylaxis, according to the researchers.

" About 50,000 very low birth weight infants (weight <1,500g) are

born each year in the United States, and approximately 4% of these

develop bloodstream infections with Candida, " said the study's lead

researcher Burwell, MD. Burwell is an epidemic intelligence

service officer in the Mycotic Diseases Branch of the CDC.

Because the rates of invasive candidiasis in neonatal care units

rates range between 1% and 4%, criteria to establish which babies

are most at risk is very important.

Researchers surveyed 20% of the 2,354 members of the AAP's Perinatal

Section. The survey asked about prophylactic use and indications for

use.

Forty-eight of the 216 respondents used fluconazole (Diflucan,

Pfizer) extensively to prevent candidemia, and 73 reported using any

type of prophylaxis, such as nystatin (59%), amphotericin B (21%),

or some other agent.

The abstract's researchers noted that gestational age or a very low

birth weight often dictated the respondent's decision to initiate

antifungal prophylaxis.

" Of the 57 who used birth weight or gestational age as an indication

to start antifungal prophylaxis, many required additional criteria

before the initiation of antifungal prophylaxis — the presence of a

central venous catheter, colonization with Candida spp., prior

antimicrobial use, prior abdominal surgery or disease or mechanical

ventilation, " they wrote.

The researchers said those who were surveyed and did not use

antifungal prophylaxis were most concerned about antifungal

resistance. Many of the surveyed participants said that they needed

more guidance for prophylaxis use before they used it routinely.

However, the researchers added, " respondents who used antifungal

prophylaxis were as likely as those who did not use antifungal

prophylaxis to believe that further efficacy studies … were needed

(69% vs. 74%, P = 0.49). "

Burwell told Infectious Diseases in Children that her team's

findings indicated a need for a more " standardized approach to

antifungal prophylaxis. "

For more information:

Burwell LA, Kaufman D, Stoll BJ, et al. Prevention of neonatal

candidemia in the United States: description of current antifungal

prophylaxis practices of neonatologists. #646. Presented at the

Pediatric Academic Societies Annual Meeting. May 14-17, 2005.

Washington.