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Challenging issues in neonatal candidiasis

Abstract In an era of quality improvement and ‘getting to zero (infections and/or related mortality),’ neonatal candidiasis is ripe for evidence-based initiatives. Knowledge of each institution’s invasive Candida infection (ICI) incidence and infection-... Full description

Journal Title: Current medical research and opinion 2010-07, Vol.26 (7), p.1769-1778
Main Author: Kaufman, David A
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Informa UK Ltd
ID: ISSN: 0300-7995
Link: https://www.ncbi.nlm.nih.gov/pubmed/20513206
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recordid: cdi_informaworld_taylorfrancis_310_1185_03007995_2010_487799
title: Challenging issues in neonatal candidiasis
format: Article
creator:
  • Kaufman, David A
subjects:
  • Antifungal Agents - adverse effects
  • Antifungal Agents - therapeutic use
  • Candidiasis - epidemiology
  • Candidiasis - mortality
  • Candidiasis - therapy
  • Carbapenem
  • Cephalosporin
  • Echinocandin
  • Female
  • Fluconazole
  • Humans
  • Incidence
  • Infant Mortality
  • Infant, Newborn
  • Infant, Newborn, Diseases - epidemiology
  • Infant, Newborn, Diseases - mortality
  • Infant, Newborn, Diseases - therapy
  • Infant, Premature
  • Prophylaxis
  • Very-low body weight
ispartof: Current medical research and opinion, 2010-07, Vol.26 (7), p.1769-1778
description: Abstract In an era of quality improvement and ‘getting to zero (infections and/or related mortality),’ neonatal candidiasis is ripe for evidence-based initiatives. Knowledge of each institution’s invasive Candida infection (ICI) incidence and infection-related mortality is critical to evaluate disease burden and effective interventions. Evidenced-based interventions include: antifungal prophylaxis, starting with appropriate dosing, and prompt removal of central venous catheters (CVC). There is A-I evidence supporting antifungal prophylaxis with fluconazole, and it should be considered in every neonatal intensive care unit (NICU). The literature supports targeting infants
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0300-7995
fulltext: fulltext
issn:
  • 0300-7995
  • 1473-4877
url: Link


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descriptionAbstract In an era of quality improvement and ‘getting to zero (infections and/or related mortality),’ neonatal candidiasis is ripe for evidence-based initiatives. Knowledge of each institution’s invasive Candida infection (ICI) incidence and infection-related mortality is critical to evaluate disease burden and effective interventions. Evidenced-based interventions include: antifungal prophylaxis, starting with appropriate dosing, and prompt removal of central venous catheters (CVC). There is A-I evidence supporting antifungal prophylaxis with fluconazole, and it should be considered in every neonatal intensive care unit (NICU). The literature supports targeting infants <1000 g and/or ≤27 weeks, because this group has high infection-related mortality and neurodevelopmental impairment in 57% of survivors. Antifungal prophylaxis has been shown to nearly eliminate infection-related mortality. Interventions start with prenatal initiatives, with women being treated for vaginal candidiasis, especially with preterm labor or complications. Targeting modifiable risk factors, including restriction policies for use of third- and fourth-generation cephalosporins, carbapenems, H2-antagonists, proton pump inhibitors, and postnatal steroids; guidelines for CVC care and removal; and feeding practices, with promotion of early feedings and breast milk, may also reduce risk. A few studies have emerged on empiric antifungal therapy with sepsis evaluations for preterm infants <1500 g and other high-risk patients that have shown favorable effects of eliminating mortality, but these have not been compared to appropriate antifungal therapy and central line removal. Further study of empiric therapy, prospective treatment studies with higher targeted dosing of amphotericin B preparations, fluconazole, and new antifungals with prompt CVC removal may contribute to a 100% survival rate for those infants >1000 g and 28 weeks not receiving antifungal prophylaxis. Evaluation of ICI incidence and mortality by gestational age and birth week should be followed in each NICU, to evaluate infection control and prevention.
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subjectAntifungal Agents - adverse effects ; Antifungal Agents - therapeutic use ; Candidiasis - epidemiology ; Candidiasis - mortality ; Candidiasis - therapy ; Carbapenem ; Cephalosporin ; Echinocandin ; Female ; Fluconazole ; Humans ; Incidence ; Infant Mortality ; Infant, Newborn ; Infant, Newborn, Diseases - epidemiology ; Infant, Newborn, Diseases - mortality ; Infant, Newborn, Diseases - therapy ; Infant, Premature ; Prophylaxis ; Very-low body weight
ispartofCurrent medical research and opinion, 2010-07, Vol.26 (7), p.1769-1778
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abstractAbstract In an era of quality improvement and ‘getting to zero (infections and/or related mortality),’ neonatal candidiasis is ripe for evidence-based initiatives. Knowledge of each institution’s invasive Candida infection (ICI) incidence and infection-related mortality is critical to evaluate disease burden and effective interventions. Evidenced-based interventions include: antifungal prophylaxis, starting with appropriate dosing, and prompt removal of central venous catheters (CVC). There is A-I evidence supporting antifungal prophylaxis with fluconazole, and it should be considered in every neonatal intensive care unit (NICU). The literature supports targeting infants <1000 g and/or ≤27 weeks, because this group has high infection-related mortality and neurodevelopmental impairment in 57% of survivors. Antifungal prophylaxis has been shown to nearly eliminate infection-related mortality. Interventions start with prenatal initiatives, with women being treated for vaginal candidiasis, especially with preterm labor or complications. Targeting modifiable risk factors, including restriction policies for use of third- and fourth-generation cephalosporins, carbapenems, H2-antagonists, proton pump inhibitors, and postnatal steroids; guidelines for CVC care and removal; and feeding practices, with promotion of early feedings and breast milk, may also reduce risk. A few studies have emerged on empiric antifungal therapy with sepsis evaluations for preterm infants <1500 g and other high-risk patients that have shown favorable effects of eliminating mortality, but these have not been compared to appropriate antifungal therapy and central line removal. Further study of empiric therapy, prospective treatment studies with higher targeted dosing of amphotericin B preparations, fluconazole, and new antifungals with prompt CVC removal may contribute to a 100% survival rate for those infants >1000 g and 28 weeks not receiving antifungal prophylaxis. Evaluation of ICI incidence and mortality by gestational age and birth week should be followed in each NICU, to evaluate infection control and prevention.
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