fungus infections in nicu

[sudershan.kumari]

There has been an increasing incidence of fungal infections in nicu babies .
I would like to know from members incidence of fungemia in their units, and whether prophylactic antifungal therapy is stared empirically or they wait for
isolation of fungs+ from blood culture or colonisation from surface.

[manuel perez valdez]

hi
to increase incidence of fungeal infections is directly proportional to use central catheters to TPN and prolonged time of antibiotics.
so many invesigators found no useful prophylactic antifungal therapy, only research it (blood and urine cultures periodically), and if you have the suspectius, start the therapy and wait it.

[manuel perez valdez]

additionally, i think this paper it's usefull
Amer J Perinatol 2007; 24: 127-135
Fungal Colonization in the Neonatal Intensive Care Unit: Risk Factors, Drug Susceptibility, and Association with Invasive Fungal Infections

[Antares]

Our neonatologists generally do not prophylactically treat for fungal infections unless the neonate is/has been on a long course or several courses of antibiotic therapy which here usually consists of cefotaxime, vancomycin and/or imipenem-cilastatin (empiric tx for any late infections) They typically use fluconazole (Diflucan) for six weeks.

[JACK]

We tried Fluconazole prophylaxis in our unit in all VLBW babies. We did not get any reassuring results.

The intervention which revealed some success in controlling our incidence of candida septicemia was restricting the use of Intralipid to deserving babies only. The decrease in the use of intralipid led to decrease in the candidemia incidence. Now intralipid use is restricted to ELBW babies in which we have difficulty in establishing feeding . We found this simple measure caused a dramatic decline in our fungal sepsis rates.

[manberbenitez]

Here in my unit ( mexico) we dont use fungus prophylaxis in any case, we try to limite the time and reasons for antibitotics uses, and try to not stay with the catheters a lot of time. we use fluconazole initially if we only suspect the presence of fungus, but whne we have the isolation of Candida we use anphotericin. have a good day

Manuel Bernal Benitez
Centerario Hospital Miguel Hidalgo
Aguascalientes Mexico
Head Neonatologist
Manberbenitez@yahoo.com.mx

[loweryp]

We have very low incidence of fungal infections in our unit. Since beginning my fellowship, I have seen no cases from our 50 bed level 3 unit or our 18 bed level 2 unit. This is likely due to our practice to minimize antibiotic use. This includes adhering to amp and gent for newborn rule outs and naf and gent for "older" baby rule outs who may have been colonized with Staph. If culture grows Staph epi, naf is switched to Vanc for possibly CONS. We do not used broad spectrum abs for initial empiric coverage unless it is highly suspected that a resistant organism will be isolated or the infant is not responding. This strategy has also limited ESBL isolates (extended spectrum b-lactam resistance in gram negatives).

pvlneofellow
Patricia V. Lowery, M.D.
Fellow of Neonatal-Perinatal Medicine
Duke Endowment Fellow for the Master's in Public Health
The Brody School of Medicine at East Carolina University
Pitt County Memorial Hospital
Greenville, N.C. 27858

[JACK]

1. David A Kaufman. Prevention of invasive Candida infections in preterm infants: the time is now [Internet]. 2008 Jul 28;[cited 2008 Nov 19 ] Available from: http://www.expert-reviews.com/doi/abs/10.1586/14787210.6.4.393?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

LINK (http://www.expert-reviews.com/doi/pdfplus/10.1586/14787210.6.4.393)