Empiric antifungal therapy and outcomes in extremely low birth weight infants with invasive candidiasis.
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Greenberg Rachel G, Benjamin Daniel K, Gantz Marie G, Cotten C Michael, Stoll Barbara J, Walsh Michele C, Sánchez Pablo J, Shankaran Seetha, Das Abhik, Higgins Rosemary D, Miller Nancy A, Auten Kathy J, Walsh Thomas J, Laptook Abbot R, Carlo Waldemar A, Kennedy Kathleen A, Finer Neil N, Duara Shahnaz, Schibler Kurt, Ehrenkranz Richard A, Van Meurs Krisa P, Frantz Ivan D, Phelps Dale L, Poindexter Brenda B, Bell Edward F, O'Shea T Michael, Watterberg Kristi L, Goldberg Ronald N, Smith P Brian, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Аннотация
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.