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J Pediatr. 2012 Aug;161(2):264-9.e2. doi: 10.1016/j.jpeds.2012.01.053. Epub 2012 Mar 15.

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

Collaborators (183)

Benjamin DK Jr, Goldberg RN, Sánchez PJ, Shankaran S, Stoll BJ, Walsh MC, Das A, Higgins RD, Miller NA, Auten KJ, Jobe AH, Caplan MS, Oh W, Vohr BR, Hensman AM, Leach TM, Watson VE, Noel L, Stephens BE, Andrews D, Angela K, Alksninis B, Ventura S, Fanaroff AA, Wilson-Costello DE, Newman NS, Friedman HG, Siner BS, Donovan EF, Steichen JJ, Yolton K, Alexander B, Bridges K, Gratton TL, Grisby C, Hessling J, Mincey HL, Goldstein RF, Fisher KA, Foy KA, Grimes S, Gustafson KE, Lohmeyer MB, Wang YF, Hale EC, Blackwelder A, Carlton DP, LaRossa MM, Carter S, Smikle G, Wineski L, Archer SW, McGowan EC, MacKinnon BL, Nylen E, Furey A, Sibley C, Brussa A, Dusick AM, Lemons JA, Cook AB, Hamer F, Herron DE, Lytle C, Minnich HM, Wilson LD, Poole W, Auman JO, Cunningham M, Hastings BK, McClure EM, Newman JE, Huitema CM, Pickett JW 2nd, Schaefer SE, Zaterka-Baxter KM, Stevenson DK, Hintz SR, Ball M, DeBattista AM, Davis AS, Kohn JG, Weiss HE, Bentley B, Brudos GK, Pyle RP, Peralta-Carcelen M, Ambalavanan N, Collins MV, Cosby SS, Biasini FJ, Johnston KC, Nelson KG, Patterson CS, Phillips VA, Rector RV, Whitley S, Rasmussen MR, Kaegi D, Vaucher YE, Arnell K, Bridge R, Demetrio C, Fuller MG, Henderson C, Rich W, Widness JA, Acarregui MJ, Johnson KJ, Eastman DL, Bauer CR, Everett-Thomas R, Worth AM, Calejo M, Diaz AN, Eguaras SM, Gideon YC, Hiriart-Fajardo S, Londono A, Mathews EO, Stroerger A, Ohls RK, Fuller J, Lacy CB, Myers GJ, Reubens LJ, Burnell E, Hust D, Jensen RL, Johnson JB, Kushner E, Yost K, Zwetsch L, Merzbach J, Rosenfeld CR, Salhab WA, Guzman A, Hensley G, Leps MH, Heyne RJ, Morgan JS, Torres LE, Boatman CT, Adams SS, Heyne E, Madden LA, Tyson JE, Evans PW, Jiminez M, Morris BH, Siddiki S, Akpa EG, Alaniz NI, Dieterich S, Harris BF, Green C, Lis AE, Martin S, McDavid GE, Tate PL, Poundstone M, Reddoch S, Simmons MC, Wright SL, Dillard RG, Peters NJ, Chiu K, Allred DE, Goldstein DJ, Peterson C, Waldrep EL, Washburn LK, Jackson BG, Pappas A, Bara R, Goldston L, Chapman RL, Gettner P, Konstantino M, Poulsen J, Romano E, Taft J, Williams J.

Author information

1
Department of Pediatrics, Duke University, Durham, NC, USA.

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.

PMID:
22424952
PMCID:
PMC3380169
DOI:
10.1016/j.jpeds.2012.01.053
[Indexed for MEDLINE]
Free PMC Article
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