Document Detail

Antifungal therapy and outcomes in infants with invasive Candida infections.
MedLine Citation:
PMID:  22189522     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Invasive candidiasis is a leading cause of mortality and morbidity in neonatal intensive care units. Treatment recommendations are limited by a lack of comparative outcomes data.
METHODS: We identified all infants ≤ 120 days of age with positive blood, urine, or cerebrospinal fluid cultures for Candida species who received amphotericin B deoxycholate, fluconazole, amphotericin B lipid products, or combination therapy admitted to one of 192 neonatal intensive care units in the United States between 1997 and 2003. Primary outcome measures included overall mortality and therapeutic failure (combined outcome of duration of infection >7 days, need for additional antifungal therapy, or death before discharge). We compared outcomes by antifungal therapy using logistic regression, controlling for gestational age, day of life at start of antifungal therapy, delay in therapy, and site of infection.
RESULTS: Overall, 138 of 730 (19%) infants died. On multivariable logistic regression, we observed higher overall mortality for infants receiving amphotericin B lipid products compared with infants receiving amphotericin B deoxycholate (odds ratio 1.96 [95% confidence intervals: 1.16, 3.33]; P = 0.01) or fluconazole (odds ratio 2.39 [1.18, 4.83]; P = 0.02).
CONCLUSIONS: Infants treated with amphotericin B lipid products had higher mortality than infants treated with either amphotericin B deoxycholate or fluconazole. This finding may be related to inadequate penetration of amphotericin B lipid products into the kidneys, inappropriate dosing in premature infants, or unknown differences in acuity of illness in infants treated with amphotericin B lipid products.
Simon B Ascher; P Brian Smith; Kevin Watt; Daniel K Benjamin; Michael Cohen-Wolkowiez; Reese H Clark; Daniel K Benjamin; Cassandra Moran
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  31     ISSN:  1532-0987     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-18     Completed Date:  2012-08-06     Revised Date:  2014-11-13    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  439-43     Citation Subset:  IM    
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MeSH Terms
Amphotericin B / therapeutic use*
Antifungal Agents / therapeutic use*
Candida / drug effects,  isolation & purification
Candidiasis, Invasive / drug therapy*,  microbiology,  mortality
Deoxycholic Acid / therapeutic use*
Drug Combinations
Fluconazole / therapeutic use*
Infant Mortality
Infant, Newborn
Intensive Care Units, Neonatal / statistics & numerical data
Logistic Models
Treatment Outcome
United States
Grant Support
1K23HD060040-01/HD/NICHD NIH HHS; 1K23HD064814-01/HD/NICHD NIH HHS; 1K24HD058735-01/HD/NICHD NIH HHS; 1R01FD003519-01/FD/FDA HHS; 1R01HD057956-02/HD/NICHD NIH HHS; 1U10-HD45962-06/HD/NICHD NIH HHS; 1UL 1RR024128-01/RR/NCRR NIH HHS; DHHS-1R18AE000028-01/AE/ASPE HHS; HHSN267200700051C/HD/NICHD NIH HHS; K23 HD060040/HD/NICHD NIH HHS; K23 HD060040-01/HD/NICHD NIH HHS; K23 HD064814/HD/NICHD NIH HHS; K23 HD064814-01/HD/NICHD NIH HHS; K24 HD058735/HD/NICHD NIH HHS; K24 HD058735-01A1/HD/NICHD NIH HHS; NIH-5UL-1RR024128-01/RR/NCRR NIH HHS; R01 HD057956/HD/NICHD NIH HHS; R01 HD057956-02/HD/NICHD NIH HHS; U10 HD045962/HD/NICHD NIH HHS; U10 HD045962-05/HD/NICHD NIH HHS; UL1 RR024128/RR/NCRR NIH HHS; UL1 RR024128-01/RR/NCRR NIH HHS
Reg. No./Substance:
0/Antifungal Agents; 0/Drug Combinations; 005990WHZZ/Deoxycholic Acid; 7XU7A7DROE/Amphotericin B; 87687-70-5/amphotericin B, deoxycholate drug combination; 8VZV102JFY/Fluconazole
Comment In:
J Pediatr. 2012 Nov;161(5):971   [PMID:  23095700 ]

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