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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Greenberg, RG; Benjamin, DK; Gantz, MG; Cotten, CM; Stoll, BJ; Walsh, MC; Sánchez, PJ; Shankaran, S; Das, A; Higgins, RD; Miller, NA; Auten, KJ; Walsh, TJ; Laptook, AR; Carlo, WA; Kennedy, KA; Finer, NN; Duara, S; Schibler, K; Ehrenkranz, RA; Van Meurs, KP; Frantz, ID; Phelps, DL; Poindexter, BB; Bell, EF; O'Shea, TM; Watterberg, KL; Goldberg, RN; Smith, PB; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network,

Published Date

  • August 2012

Published In

Volume / Issue

  • 161 / 2

Start / End Page

  • 264 - 9.e2

PubMed ID

  • 22424952

Pubmed Central ID

  • PMC3380169

Electronic International Standard Serial Number (EISSN)

  • 1097-6833

Digital Object Identifier (DOI)

  • 10.1016/j.jpeds.2012.01.053


  • eng

Conference Location

  • United States