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Journal of Pediatrics, The

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Empiric Antifungal Therapy and Outcomes in Extremely Low Birth Weight Infants with Invasive Candidiasis - 24/07/12

Doi : 10.1016/j.jpeds.2012.01.053 
Rachel G. Greenberg, MD 1, Daniel K. Benjamin, MD, PhD, MPH 1, Marie G. Gantz, PhD 2, C. Michael Cotten, MD 1, Barbara J. Stoll, MD 3, Michele C. Walsh, MD 4, Pablo J. Sánchez, MD 5, Seetha Shankaran, MD 6, Abhik Das, PhD 7, Rosemary D. Higgins, MD 8, Nancy A. Miller, RN 5, Kathy J. Auten, MSHS 1, Thomas J. Walsh, MD 9, Abbot R. Laptook, MD 10, Waldemar A. Carlo, MD 11, Kathleen A. Kennedy, MD, MPH 12, Neil N. Finer, MD 13, Shahnaz Duara, MD 14, Kurt Schibler, MD 15, Richard A. Ehrenkranz, MD 16, Krisa P. Van Meurs, MD 17, Ivan D. Frantz, MD 18, Dale L. Phelps, MD 19, Brenda B. Poindexter, MD 20, Edward F. Bell, MD 21, T. Michael O’Shea, MD, MPH 22, Kristi L. Watterberg, MD 23, Ronald N. Goldberg, MD 1, P. Brian Smith, MD, MPH, MHS 1

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

  Members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network is available at www.jpeds.com (Appendix).

1 Department of Pediatrics, Duke University, Durham, NC 
2 Research Statistics Unit, Research Triangle Institute International, Research Triangle Park, NC 
3 Department of Pediatrics, Emory University, Atlanta, GA 
4 Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH 
5 Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 
6 Department of Pediatrics, Wayne State University, Detroit, MI 
7 Statistics and Epidemiology Unit, Research Triangle Institute International, Rockville, MD 
8 Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 
9 National Cancer Institute, National Institutes of Health, Bethesda, MD 
10 Department of Pediatrics, Women & Infant’s Hospital, Brown University, Providence, RI 
11 Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 
12 Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX 
13 Department of Pediatrics, University of California San Diego, La Jolla, CA 
14 Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 
15 Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 
16 Department of Pediatrics, Yale University School of Medicine, New Haven, CT 
17 Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 
18 Department of Pediatrics, Tufts Medical Center, Boston, MA 
19 Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 
20 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 
21 Department of Pediatrics, University of Iowa, Iowa City, IA 
22 Department of Pediatrics, Wake Forest University, Winston-Salem, NC 
23 Department of Pediatrics, University of New Mexico Health Science Center, Albuquerque, NM 

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.

Le texte complet de cet article est disponible en PDF.

Mots-clés : BPD, ELBW, EOD, NDI, NICU, ROP


Plan


 The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development provided grant support for the Neonatal Research Network’s Candidiasis Study.
 D.B. receives support from the United States Government for his work in pediatric and neonatal clinical pharmacology (1R01HD057956-02, 1R01FD003519-01, 1U10-HD45962-06, 1K24HD058735-01, and government contract HHSN267200700051C), the nonprofit Thrasher Research Foundation for his work in neonatal candidiasis, and Astellas Pharma US, CV Therapeutics, Inc, Johnson and Johnson, Pangen Biosystems, Inc, and Pzifer for neonatal and pediatric drug development. B.S. received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grants 1K23HD060040-01 and 1R18AE000028-01). Data collected at participating sites of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network were transmitted to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. Study sponsors were not involved in the study design; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit the manuscript for publication. The other authors declare no conflicts of interest.


© 2012  Mosby, Inc. Tous droits réservés.
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Vol 161 - N° 2

P. 264 - août 2012 Retour au numéro
Article précédent Article précédent
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