Time to Initiation of Antifungal Therapy for Neonatal Candidiasis.
Antimicrob Agents Chemother. 2013 Mar 18;
Authors: Le J, Tran TT, Bui I, Wang MK, Vo A, Adler-Shohet FC
Background:The effect of delayed antifungal therapy has not been studied in critically-ill infants with invasive candidiasis. Our objective was to evaluate the effect of time to initiation of antifungal therapy (TIA) on mortality, disseminated disease and post-infection hospital stay.Methods:We conducted a cohort study of critically-ill infants with positive cultures for Candida from 1990 to 2008. TIA was defined as the number of hours (hrs) from the collection of the first positive culture until the start of antifungal therapy.Results:Of 96 infants, 57% were male, median gestational age was 27 (range 23-41) weeks, and birthweight was 956 (415-6191) grams. Most subjects received amphotericin B deoxycholate. TIA was ≤ 24 hrs for 35% of infants, between 25-48 hrs for 42%, and >48 hrs for 23%. Eleven subjects died during hospitalization, and 22% had disseminated candidiasis. Median duration of hospital stay post-infection was 53 (6-217) days. Both univariate and multivariate analyses demonstrated that TIA was not associated with mortality, disseminated disease, or hospital stay post-infection. However, ventilator use for > 60 days significantly increased the risk of death (odds ratio [OR] = 9.5; 95% confidence interval (CI) 2.2-66.7, p=0.002). Prolonged candidemia increased the risk of disseminated disease by 10% per day of positive culture (OR = 1.1; 95% CI 1.08-1.2, p=0.007) and low gestational age was associated with increased NICU stay after first positive Candida culture by 0.94 week (95% CI 0.70-0.98, p<0.001).Conclusion:The TIA was not associated with all-cause mortality, disseminated candidiasis, and post-infection length of hospital stay.
PMID: 23507285 [PubMed - as supplied by publisher]