Management of neonatal candidiasis

Judith L. Rowen, Judy M. Tate

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Objective. To identify areas of consensus and controversy in the management of neonatal candidiasis. Methods. A questionnaire was distributed to US-based members of the Pediatric Infectious Diseases Society and a sampling of US neonatologists. Results. Three hundred eighty evaluable questionnaires were returned (42% of those mailed). Ninety-five percent of respondents have cared for an infant with systemic candidiasis in the past 2 years. Fluconazole and liposomal amphotericin are used to some extent by 90 and 69% of respondents, respectively. A single blood culture positive for Candida led to a recommendation for immediate treatment by 99%; amphotericin B was the preferred therapy for candidemia (88%). More than 80% of respondents would request cerebrospinal fluid, urine and repeat blood cultures and ophthalmologic examination in the evaluation of candidemia. If a cerebrospinal fluid culture is positive, 25% would use amphotericin B alone whereas 62% would add flucytosine. For candiduria Society members chose fluconazole therapy more often than did neonatologists, 23% vs. 3.4% (P < 0.001). There was no consensus concerning duration of therapy, use of an amphotericin B test dose or management of a central catheter in place during candidemia. Conclusions. Systemic candidiasis in neonates is frequently encountered clinical problem. There is agreement that prompt therapy with amphotericin B is required if a blood culture is positive for Candida and that such infants require additional evaluations. Other antifungals (fluconazole, liposomal amphotericin B) are used to some extent in this population. Many issues in management have no clear consensus and warrant further research.

Original languageEnglish (US)
Pages (from-to)1007-1011
Number of pages5
JournalPediatric Infectious Disease Journal
Volume17
Issue number11
DOIs
StatePublished - Nov 1998

Keywords

  • Amphotericin B
  • Candida
  • Candidiasis
  • Fluconazole
  • Liposomal amphotericin B
  • Neonate
  • Prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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