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Clinical changes likely led to reduction of invasive candidiasis rates
The decrease of incidence rates of invasive candidiasis in the neonatal ICU could be attributed to the increased use of fluconazole prophylaxis and empirical antifungal therapy, as well as decreased use of broad-spectrum antibacterial antibiotics, according to recent study findings published in Pediatrics.
“Our findings show a substantial decrease in the incidence of invasive candidiasis in the [neonatal] ICU setting,” the researchers wrote. “This decrease was likely the result of progressive changes in neonatal clinical practice. The decreased incidence of invasive candidiasis will likely not only reduce overall health care costs but also improve neonatal outcomes.”
P. Brian Smith, MD, MPH, MHS, of the department of pediatrics, Duke Clinical Research Institute, Duke University, and colleagues evaluated 709,325 infants at 322 neonatal ICUs from 1997 to 2010 to determine the association of invasive candidiasis and antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotics use changed over time. Overall, 0.3% of patients had 2,101 episodes of invasive candidiasis.
There was a 19.9% mortality rate for patients with invasive candidiasis compared with 2.1% for infants without invasive candidiasis (P<.001). During the study period, the rate of invasive candidiasis decreased from 3.6 per 1,000 patients to 1.4 per 1,000 patients.
Overall, 0.4% of patients received antifungal prophylaxis; fluconazole was the most frequently used (92.7%). Fluconazole use increased during the study period, from 0.1 per 1,000 patients to 7.4 per 1,000 patients.
Overall, 7,494 patients received one or more course of empirical treatment, including 3,959 courses of amphotericin and 4,209 courses of fluconazole. Eight percent of those who received empirical therapy developed invasive candidiasis. Empirical antifungal treatment use increased from 4 per 1,000 patients to 11.5 per 1,000 patients during the study period.
Patients receiving broad-spectrum antibiotics decreased from 275.2 per 1,000 patients to 48.5 per 1,000 patients during the study period.
“Each [neonatal] ICU should closely monitor its incidence of invasive candidiasis because low rates are achievable,” the researchers wrote. “Similar to preventing central line-associated bloodstream infections and group B Streptococcus, we want to eliminate these infections. Additional clinical trials addressing the efficacy of antifungal therapy may not be feasible given the current incidence of the disease. A comparison of practices between [neonatal] ICUs with high and low rates of candidiasis may be helpful in providing further evidence for best practices in the prevention of this disease.”
Disclosure: See study for a full list of financial disclosures.