Empiric antifungal therapy and outcomes in extremely low birth weight infants with invasive candidiasis

Rachel G. Greenberg, Daniel K. Benjamin, Marie G. Gantz, C. Michael Cotten, Barbara J. Stoll, Michele C. Walsh, Pablo J. Sánchez, Seetha Shankaran, Abhik Das, Rosemary D. Higgins, Nancy A. Miller, Kathy J. Auten, Thomas J. Walsh, Abbot R. Laptook, Waldemar A. Carlo, Kathleen A. Kennedy, Neil N. Finer, Shahnaz Duara, Kurt Schibler, Richard A. EhrenkranzKrisa P. Van Meurs, Ivan D. Frantz, Dale L. Phelps, Brenda B. Poindexter, Edward F. Bell, T. Michael O'Shea, Kristi L. Watterberg, Ronald N. Goldberg, P. Brian Smith

Research output: Contribution to journalArticle

29 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)264-269.e2
JournalJournal of Pediatrics
Volume161
Issue number2
DOIs
StatePublished - Aug 2012

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Greenberg, R. G., Benjamin, D. K., Gantz, M. G., Cotten, C. M., Stoll, B. J., Walsh, M. C., Sánchez, P. J., Shankaran, S., Das, A., Higgins, R. D., Miller, N. A., Auten, K. J., Walsh, T. J., Laptook, A. R., Carlo, W. A., Kennedy, K. A., Finer, N. N., Duara, S., Schibler, K., ... Smith, P. B. (2012). Empiric antifungal therapy and outcomes in extremely low birth weight infants with invasive candidiasis. Journal of Pediatrics, 161(2), 264-269.e2. https://doi.org/10.1016/j.jpeds.2012.01.053