Published online September 18, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1019-e1026 (doi:10.1542/peds.2006-0446)
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ARTICLE

Antifungal Prophylaxis to Prevent Neonatal Candidiasis: A Survey of Perinatal Physician Practices

Lauren A. Burwell, MDa,b, David Kaufman, MDc, Jennifer Blakely, MPHb, Barbara J. Stoll, MDd and Scott K. Fridkin, MDb

a Office of Workforce and Career Development
b Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
c Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
d Department of Pediatrics, Emory University, Atlanta, Georgia

BACKGROUND. Bloodstream infections with Candida species have a high mortality rate in very low birth weight infants. Preliminary data suggest that prophylaxis with fluconazole reduces the incidence of colonization and invasive Candida infections in high-risk, very low birth weight neonates. The extent of antifungal prophylaxis use to prevent neonatal candidemia is unknown.

METHODS. We surveyed a 20% random sample of the members of the American Academy of Pediatrics Section on Perinatal Pediatrics. We collected information on prophylactic agents used, indications for use, and rationale for reported practices.

RESULTS. A total of 219 (47%) of 469 members sampled responded; 3 clinicians who did not provide care to very low birth weight infants were excluded. Antifungal prophylaxis use was reported by 73 (34%) respondents. Agents used included intravenous fluconazole (66%), oral nystatin (59%), and intravenous amphotericin B (21%). Decreased birth weight or early gestational age was the most frequent indication to start prophylaxis (57 [78%]). Respondents who did not use antifungal prophylaxis compared with respondents who used fluconazole prophylaxis were significantly more likely to have concerns about (1) the emergence of antifungal resistance, (2) unclear criteria on which to base the decision to start prophylaxis, and (3) the need for clarification of the role of surveillance cultures.

CONCLUSIONS. Although preliminary data suggest that fluconazole is efficacious to prevent candidemia in a subset of neonates, this practice is not used widely by clinicians who care for very low birth weight infants. Additional efficacy studies should address the emergence of antifungal resistance or clarification of criteria to initiate prophylaxis, including the role of surveillance cultures.

Key Words: candidemia • prophylaxis • prevention • sepsis • survey

Abbreviations: VLBW—very low birth weight • ELBW—extremely low birth weight • AAP—American Academy of Pediatrics

Accepted May 23, 2006.


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