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Dornelas-Figueira LM, Ricomini Filho AP, Junges R, Åmdal HA, Cury AADB, Petersen FC. In Vitro Impact of Fluconazole on Oral Microbial Communities, Bacterial Growth, and Biofilm Formation. Antibiotics (Basel) 2023; 12:1433. [PMID: 37760729 PMCID: PMC10525723 DOI: 10.3390/antibiotics12091433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Antifungal agents are widely used to specifically eliminate infections by fungal pathogens. However, the specificity of antifungal agents has been challenged by a few studies demonstrating antibacterial inhibitory effects against Mycobacteria and Streptomyces species. Here, we evaluated for the first time the potential effect of fluconazole, the most clinically used antifungal agent, on a human oral microbiota biofilm model. The results showed that biofilm viability on blood and mitis salivarius agar media was increased over time in the presence of fluconazole at clinically relevant concentrations, despite a reduction in biomass. Targeted PCR revealed a higher abundance of Veillonella atypica, Veillonella dispar, and Lactobacillus spp. in the fluconazole-treated samples compared to the control, while Fusobacterium nucleatum was reduced and Streptococcus spp were not significantly affected. Further, we tested the potential impact of fluconazole using single-species models. Our results, using Streptococcus mutans and Streptococcus mitis luciferase reporters, showed that S. mutans planktonic growth was not significantly affected by fluconazole, whereas for S. mitis, planktonic growth, but not biofilm viability, was inhibited at the highest concentration. Fluconazole's effects on S. mitis biofilm biomass were concentration and time dependent. Exposure for 48 h to the highest concentration of fluconazole was associated with S. mitis biofilms with the most increased biomass. Potential growth inhibitory effects were further tested using four non-streptococcal species. Among these, the planktonic growth of both Escherichia coli and Granulicatella adiacens was inhibited by fluconazole. The data indicate bacterial responses to fluconazole that extend to a broader range of bacterial species than previously anticipated from the literature, with the potential to disturb biofilm communities.
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Affiliation(s)
- Louise Morais Dornelas-Figueira
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, 0372 Oslo, Norway
| | - Antônio Pedro Ricomini Filho
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil
| | - Roger Junges
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, 0372 Oslo, Norway
| | - Heidi Aarø Åmdal
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, 0372 Oslo, Norway
| | - Altair Antoninha Del Bel Cury
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil
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Valenzuela-Stutman D, Romero AM, Astudillo P. Prophylactic fluconazole protocol in very low birth weight infants: invasive candidiasis prevention in a Latin American neonatal intensive care unit. J Perinatol 2023; 43:1139-1144. [PMID: 37253780 DOI: 10.1038/s41372-023-01699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 03/29/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the effect of prophylactic fluconazole for very low birth weight infants (VLBWI) in a neonatal intensive care unit (NICU) with a 7.8% incidence of invasive candidiasis (IC). STUDY DESIGN Interventional pre-post cohort study comparing 2 years with and without fluconazole prophylaxis protocol (2016-2018 = 228 infants and 2019-2021 = 125 infants). Fluconazole was administered to all extremely low birth weight infants (ELBWI) and infants with BW 1001-1500 g with risk factors or positive carrier cultures. Liver function tests were performed weekly. RESULTS The incidence of IC decreased from 7.8% to 2.4% (OR:0.3, p = 0.05) with the use of prophylactic fluconazole for VLBWI and in ELBWI decreased from 16,7% to 3,7% (OR:0.1, p = 0.04). No significant differences were seen in mortality. CONCLUSIONS Fluconazole is a safe, effective, and feasible strategy to prevent IC in a Latin American country.
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Affiliation(s)
| | - Andrea Maccioni Romero
- Neonatology Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile.
- Neonatology Department, Pediatric Division, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Patricio Astudillo
- Pediatric Infectious Disease Department, Pediatric Division, Pontificia Universidad Católica de Chile, Santiago, Chile
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Arun S, Varghese M, Cherian T, Ramaswami P. Current Trends in Antifungal Prophylaxis for High-Risk Neonates in Neonatal Intensive Care Units in India: A Nationwide Survey. Cureus 2023; 15:e36136. [PMID: 36926274 PMCID: PMC10013975 DOI: 10.7759/cureus.36136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Background Prophylactic antifungals are often used in high-risk babies in neonatal intensive care units (NICUs) to reduce invasive fungal infections (IFIs). However, existing guidelines regarding prophylactic antifungal usage do not clearly define the high-risk population. This study aimed to assess the practices related to prophylactic antifungal use in NICUs in India. Methods For this cross-sectional study, an online structured questionnaire was completed by neonatologists who worked in level 3 NICUs in 12 states in India during the period June 2022 to August 2022. Results Data from 151 NICUs were analyzed. 71.7% of respondents were from private hospitals, and 28.3% were from government hospitals. Nearly one-fourth of the units (28.5%) used antifungal prophylaxis in all extremely low birth weight (ELBW) babies, while another one-fourth (25.8%) used a case-based approach. The remaining NICUs (45.7%) did not use prophylactic antifungals. Among the users, the preferred antifungal was fluconazole; 3 mg/kg and 6 mg/kg were the dosage regimens used. The commonly used interval for administering fluconazole was 72 hours (69.2% of units). The intravenous route was the preferred route of administration (84.1%). Factors that influenced the non-users were the low incidence of fungal infections in their NICUs and concern about the development of resistance. It was noted that the users felt strongly about the need for further recommendations from pediatric societies and more studies on the efficacy of antifungals. Conclusion There is considerable variation in the use of prophylactic antifungals across NICUs in India. Among the users, uniformity in the choice of antifungal and interval of administration was observed. Further recommendations from pediatric societies, including the definitions of neonates at-risk of fungal infections, are required to ensure consistency in practice and help clinicians decide whether or not to use prophylactic antifungals.
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Affiliation(s)
- Sumitha Arun
- Neonatology, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Mereta Varghese
- Neonatology, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Taliya Cherian
- Neonatology, Believers Church Medical College Hospital, Thiruvalla, IND
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Lona-Reyes JC, Gómez-Ruiz LM, Cordero-Zamora A, Cortés-González SI, Quiles-Corona M, Pérez-Ramírez RO, Pinto-Macedo H. Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico. An Pediatr (Barc) 2022; 97:79-86. [PMID: 35850964 DOI: 10.1016/j.anpede.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/04/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS Case-control study nested in a cohort and matched for birth weight. We estimated the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04, 95% CI 1.13-8.14), systemic antibiotics (OR 7.48, 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02, 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14, 95% CI 1.04-1.25) or with venous catheter central (OR 1.11, 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32, 95% CI 0.12-0.84). CONCLUSIONS Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
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Affiliation(s)
- Juan C Lona-Reyes
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México.
| | - Larissa M Gómez-Ruiz
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Araceli Cordero-Zamora
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México
| | - Sandra I Cortés-González
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Moisés Quiles-Corona
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Rene O Pérez-Ramírez
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Herlinda Pinto-Macedo
- Laboratorio Clínico y Microbiología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
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Smith B, Rajapakse N, Sauer HE, Ellsworth K, Dinnes L, Madigan T. A Quality Improvement Project Aimed at Standardizing the Prescribing of Fluconazole Prophylaxis in a Level IV Neonatal Intensive Care Unit. Pediatr Qual Saf 2022; 7:e579. [PMID: 38585424 PMCID: PMC10997225 DOI: 10.1097/pq9.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Invasive candidiasis has a high morbidity and mortality among premature neonates. Antifungal prophylaxis with fluconazole significantly lowers the risk of invasive fungal infection in this population. We noted the use of fluconazole prophylaxis in our level IV neonatal intensive care unit (NICU) was variable and sought to standardize prescribing of prophylactic fluconazole. Methods We formed a multidisciplinary team to develop an evidence-based protocol using literature and expert consensus to guide appropriate use of fluconazole prophylaxis in our level IV NICU. After determining baseline fluconazole prophylaxis prescribing before protocol implementation, we used plan-do-study-act (PDSA) cycles to introduce protocolized prescribing and incorporate it into daily practice. A 6-month intervention phase was followed by a 2-year control phase, in which monthly audits were performed to evaluate protocol adherence. Results were displayed in a statistical process control chart. Results Before protocol implementation, fluconazole prophylaxis prescribing adhered to the protocol in 81% of patients. During the first PDSA cycle, adherence increased significantly to 94.5% (86/91 patients), which further increased to 98.7% (74/75 patients) during the second PDSA cycle and remained at 96% (120/125 patients) during the control phase (P < 0.0001). Conclusions A multidisciplinary group-designed protocol was successful in standardizing fluconazole prophylaxis prescribing for infants in the level IV NICU. Adherence to protocol was high following implementation and was sustained for the duration of the project. There were no cases of invasive candidiasis noted.
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Affiliation(s)
- Brandi Smith
- From the Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Nipunie Rajapakse
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hannah E. Sauer
- Pharmacy Department, Texas Children’s Hospital, Houston, Texas
| | | | - Laura Dinnes
- From the Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Theresa Madigan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Lona-Reyes JC, Gómez-Ruiz LM, Cordero-Zamora A, Cortés-González SI, Quiles-Corona M, Pérez-Ramírez RO, Pinto-Macedo H. [Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico]. An Pediatr (Barc) 2021; 97:S1695-4033(21)00235-6. [PMID: 34334329 DOI: 10.1016/j.anpedi.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/26/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84). CONCLUSIONS Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
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Affiliation(s)
- Juan C Lona-Reyes
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México.
| | - Larissa M Gómez-Ruiz
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Araceli Cordero-Zamora
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México
| | - Sandra I Cortés-González
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Moisés Quiles-Corona
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Rene O Pérez-Ramírez
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Herlinda Pinto-Macedo
- Laboratorio Clínico y Microbiología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
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Robati Anaraki M, Nouri-Vaskeh M, Abdoli Oskoei S. Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis. Clin Exp Pediatr 2021; 64:172-179. [PMID: 32683818 PMCID: PMC8024115 DOI: 10.3345/cep.2019.01431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/29/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Evidence shows that fluconazole prophylaxis is an effective treatment against invasive fungal infections in preterm neonates, however, the most efficient schedule of fluconazole prophylaxis for the colonization and mortality of invasive candidiasis (IC) is unknown. PURPOSE This systematic review and meta-analysis aimed to assess the efficiency of different prophylactic fluconazole schedules in controlling IC colonization, infection, and mortality in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in neonatal intensive care units. METHODS We searched the PubMed, Scopus, Embase, and Cochrane databases using the keywords "candida," "invasive candidiasis," "IC," "fluconazole prophylaxis," "preterm infants," "very low birth weight infants," "VLBW," "extremely low birth weight," and "ELBW." RESULTS Mortality was significantly decreased in a metaanalysis of studies using different fluconazole prophylaxis regimens. The meta-analysis also indicated a significant decrease in the incidence of IC-associated mortality in ELBW infants using the same fluconazole prophylaxis schedules. CONCLUSION Future studies should explore the effectiveness of other different fluconazole prophylaxis schedules on IC colonization, infection, and mortality.
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Affiliation(s)
- Mahmoud Robati Anaraki
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Prosthodontics, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nouri-Vaskeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahram Abdoli Oskoei
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Xia XH, Lin L, Zi-Yu H. [Efficacy and safety of fluconazole in prophylaxis of invasive fungal infections in very low birth weight infants: a Meta analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:446-453. [PMID: 32434639 PMCID: PMC7389408 DOI: 10.7499/j.issn.1008-8830.1911012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of fluconazole in the prophylaxis of invasive fungal infection in very low birth weight (VLBW) infants. METHODS Databases including PubMed, Embase, the Cochrane Library, Wanfang Data, Weipu, and CNKI were searched for randomized controlled trials (RCTs) of prophylactic fluconazole in VLBW infants. Review Manager 5.3 software was used to perform a Meta analysis of the included studies. RESULTS A total of 12 RCTs were included, involving 1 679 VLBW infants. The Meta analysis showed that prophylactic fluconazole significantly reduced the incidence of invasive fungal infection (RR=0.44, 95%CI: 0.27-0.71, P<0.001), the incidence of fungal colonization (RR=0.31, 95%CI: 0.24-0.40, P<0.001), and the mortality during hospitalization (RR=0.74, 95%CI: 0.58-0.94, P=0.01) compared with the control group. There were no significant differences between VLBW infants using different doses of fluconazole in the incidence of invasive fungal infection and fungal colonization (P>0.05). No significant differences were found in the incidence of fluconazole resistance and complications between the fluconazole and control groups (P>0.05). CONCLUSIONS Prophylactic fluconazole can effectively and safely prevent invasive fungal infection in VLBW infants, even at a small dose.
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Affiliation(s)
- Xu-Hua Xia
- Department of Medical General Ward, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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Abstract
Abstract
Infections belong to the most serious health problems in neonates. Invasive candidiases are one of the leading causes of mortality and morbidity in Neonatal intensive care units (NICUs). A more cautious approach is adequate when dealing with fungal infections in premature neonates. Sometimes it is necessary to cure an infection at the very beginning just before manifestation of clinical symptoms. Neonatal colonization due to Candida albicans or non-albicans Candidae predisposes to invasive candidiasis. Pregnancies complicated by preterm delivery should be considered for screening and treatment of maternal Candida colonization to decrease the occurrence of neonatal fungal colonization and its consequences. It is important to prevent infection to spread among patients and avoid complications. Prophylaxis in neonates must be safe and effective. Most authors prefer selective prophylaxis. Fluconazole is the drug of choice for prophylaxis in extremely low birth weight (ELBW) neonates. The prophylaxis is beneficial especially in NICUs with high rates of invasive candidiases. The authors describe benefits and trends in prophylaxis. They also summarize evidence on timing, dosing, and effect of fluconazole prophylaxis.
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Silva-Rios J, Camargos P, Correa L, Romanelli R. Prophylactic regimens with fluconazole for candidiasis in neonates under 1.500g: A retrospective chart review of two cohorts. J Neonatal Perinatal Med 2019; 12:29-36. [PMID: 30958318 DOI: 10.3233/npm-17121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The incidence rate of invasive candidiasis in newborns with birth weight below 1,500 g ranges from 2% to 8%, and fluconazole prophylaxis in neonatal units is recommended when the incidence of invasive candidiasis is higher than 5%. This study aimed to compare the effectiveness of targeted prophylaxis and universal prophylaxis with fluconazole in the prevention of invasive candidiasis. METHODS This was a historical cohort comparing the targeted prophylaxis for newborns weighing less than 1,500 g and the universal prophylaxis for newborns weighing less than 1,000 g. RESULTS The overall incidence rate of invasive candidiasis was 5.25% and was reduced from 7.1% to 3.72% with universal prophylaxis (p = 0.04). In a multivariate analysis, the significant factors associated with the development of candidiasis were birth weight less than 1,000 g, prolonged hospitalization, previous surgery, prolonged use of mechanical ventilation, prior exposure to antimicrobial treatments, and use of targeted prophylaxis. CONCLUSIONS Universal prophylaxis had lower incidence of invasive candidiasis, and preventive measures considering the risk factors are mandatory to reduce the incidence of invasive candidiasis.
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Affiliation(s)
- J Silva-Rios
- Hospital Sofia Feldman, Belo Horizonte, Minas Gerais, Brazil
- Post-Graduation Center, Medical School, Federal University of Minas Gerais (UFMG), Belo Horizonte, M.G., Brazil
| | - P Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais (UFMG), Belo Horizonte, M.G., Brazil
| | - L Correa
- Medical School Federal University of Minas Gerais (UFMG), Belo Horizonte, M.G., Brazil
| | - R Romanelli
- Department of Pediatrics, Medical School, Federal University of Minas Gerais (UFMG), Belo Horizonte, M.G., Brazil
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Ramos JT, Romero CA, Belda S, Candel FJ, Gallego BC, Fernández-Polo A, Antolín LF, Colino CG, Navarro ML, Neth O, Olbrich P, Rincón-López E, Contreras JR, Soler-Palacín P. Clinical practice update of antifungal prophylaxis in immunocompromised children. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:410-425. [PMID: 31507152 PMCID: PMC6790888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Due to the rise in the number and types of immunosuppressed patients, invasive fungal infections (IFI) are an increasing and major cause of morbidity and mortality in immunocompromised adults and children. There is a broad group of pediatric patients at risk for IFI in whom primary and/or secondary antifungal prophylaxis (AFP) should be considered despite scant evidence. Pediatric groups at risk for IFI includes extremely premature infants in some settings, while in high-risk children with cancer receiving chemotherapy or undergoing haematopoietic stem cell transplantation (HCT), AFP against yeast and moulds is usually recommended. For solid organ transplanted, children, prophylaxis depends on the type of transplant and associated risk factors. In children with primary or acquired immunodeficiency such as HIV or long-term immunosuppressive treatment, AFP depends on the type of immunodeficiency and the degree of immunosuppression. Chronic granulomatous disease is associated with a particular high-risk of IFI and anti-mould prophylaxis is always indicated. In contrast, AFP is not generally recommended in children with long stay in intensive care units. The choice of AFP is limited by the approval of antifungal agents in different age groups and by their pharmacokinetics characteristics. This document aims to review current available information on AFP in children and to provide a comprehensive proposal for each type of patient.
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Affiliation(s)
- José Tomás Ramos
- Department of Public and Mother-Child Health. Hospital Clínico San Carlos, Complutense University. Madrid.,Correspondence: José T. Ramos Amador Departmento de Salud Pública y Materno-Infantil. Complutense University. Madrid. Hospital Clínico San Carlos. IdISSC Health Research Institute Madrid. Spain. Avda Profesor Martín Lagos s/n. 28040. Phone: + 34 91 330 3486 E-mail:
| | - Concepción Alba Romero
- Department of Salud Pública y Materno-Infantil.Complutense University. Neonatology Unit. Hospital 12 de Octubre. Madrid
| | - Sylvia Belda
- Department of Pediatrics. Intensive Care Unit. Hospital 12 de Octubre. Madrid. Complutense University. Madrid
| | - Francisco Javier Candel
- Clinical Microbiology and Infectious Diseases Department. Transplant. Coordination Unit. IdISSC and IML Health Institutes. Hospital Clínico San Carlos. Madrid. Spain
| | - Begoña Carazo Gallego
- Department of Pediatrics. Sección de Enfermedades Infecciosas. Hospital Carlos Haya, Málaga
| | | | | | - Carmen Garrido Colino
- Department of Pediatrics. Sección de Hemato-oncología. Hospital Gregorio Marañón. Madrid
| | - María Luisa Navarro
- Department of Pediatrics. Sección de Enfermedades Infecciosas. Hospital Gregorio Marañón. Madrid
| | - Olaf Neth
- Department of Pediatrics. Sección Infectología, Reumatología e Inmunología Pediátrica. Hospital Universitario Virgen del Rocío, Sevilla
| | - Peter Olbrich
- Department of Pediatrics. Sección Infectología, Reumatología e Inmunología Pediátrica. Hospital Universitario Virgen del Rocío, Sevilla
| | - Elena Rincón-López
- Department of Pediatrics. Sección de Enfermedades Infecciosas. Hospital Gregorio Marañón. Madrid
| | - Jesús Ruiz Contreras
- Department of Pediatrics. Hospital 12 de Octubre. Madrid. Complutense University. Madrid
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit. Hospital Universitari Vall d’Hebron. Barcelona
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Prevention of Invasive Candidiasis in Premature Neonates: Administering Fluconazole or Not? CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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