Empiric Antifungal Therapy and Outcomes in Extremely Low Birth Weight Infants with Invasive Candidiasis

• Rachel G. Greenberg, MD
,
• Daniel K. Benjamin Jr., MD, PhD, MPH
,
• Marie G. Gantz, PhD
,
• C. Michael Cotten, MD
,
• Barbara J. Stoll, MD
,
• Michele C. Walsh, MD
,
• Pablo J. Sánchez, MD
,
• Seetha Shankaran, MD
,
• Abhik Das, PhD
,
• Rosemary D. Higgins, MD
,
• Nancy A. Miller, RN
,
• Kathy J. Auten, MSHS
,
• Thomas J. Walsh, MD
,
• Abbot R. Laptook, MD
,
• Waldemar A. Carlo, MD
,
• Kathleen A. Kennedy, MD, MPH
,
• Neil N. Finer, MD
,
• Shahnaz Duara, MD
,
• Kurt Schibler, MD
,
• Richard A. Ehrenkranz, MD
,
• Krisa P. Van Meurs, MD
,
• Ivan D. Frantz III, MD
,
• Dale L. Phelps, MD
,
• Brenda B. Poindexter, MD
,
• Edward F. Bell, MD
,
• T. Michael O'Shea, MD, MPH
,
• Kristi L. Watterberg, MD
,
• Ronald N. Goldberg, MD
,
• P. Brian Smith, MD, MPH, MHS
,
• Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Abstract

Objective

To assess the impact of empiric antifungal therapy for invasive candidiasis on subsequent outcomes in premature infants.

Study design

This was a cohort study of infants with a birth weight ≤1000 g receiving care at Neonatal Research Network sites. All infants had at least one positive culture for Candida. Empiric antifungal therapy was defined as receipt of a systemic antifungal on the day of or the day before the first positive culture for Candida was drawn. We created Cox proportional hazards and logistic regression models stratified on propensity score quartiles to determine the effect of empiric antifungal therapy on survival, time to clearance of infection, retinopathy of prematurity, bronchopulmonary dysplasia, end-organ damage, and neurodevelopmental impairment (NDI).

Results

A total of 136 infants developed invasive candidiasis. The incidence of death or NDI was lower in infants who received empiric antifungal therapy (19 of 38; 50%) compared with those who had not (55 of 86; 64%; OR, 0.27; 95% CI, 0.08-0.86). There was no significant difference between the groups for any single outcome or other combined outcomes.

Conclusion

Empiric antifungal therapy was associated with increased survival without NDI. A prospective randomized trial of this strategy is warranted.

Recuperado em 2012, Abril 10. Disponível em

http://www.jpeds.com/article/S0022-3476(12)00111-4/abstract