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Neonatal Antifungal Consumption Is Dominated by Prophylactic Use; Outcomes From The Pediatric Antifungal Stewardship: Optimizing Antifungal Prescription Study.

Ferreras-Antolín, L; Irwin, A; Atra, A; Dermirjian, A; Drysdale, SB; Emonts, M; McMaster, P; Paulus, S; Patel, S; Kinsey, S; et al. Ferreras-Antolín, L; Irwin, A; Atra, A; Dermirjian, A; Drysdale, SB; Emonts, M; McMaster, P; Paulus, S; Patel, S; Kinsey, S; Vergnano, S; Whittaker, E; Warris, A (2019) Neonatal Antifungal Consumption Is Dominated by Prophylactic Use; Outcomes From The Pediatric Antifungal Stewardship: Optimizing Antifungal Prescription Study. Pediatr Infect Dis J, 38 (12). pp. 1219-1223. ISSN 1532-0987 https://doi.org/10.1097/INF.0000000000002463
SGUL Authors: Sharland, Michael Roy Drysdale, Simon Bruce

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Abstract

BACKGROUND: Diagnostic challenges combined with the vulnerability of neonates to develop invasive candidiasis (IC) may lead to antifungal administration in the absence of IC. A modified point-prevalence study was performed to obtain an improved insight and understanding of antifungal prescribing in this specific patient population. METHODS: Neonates and infants ≤90 days of age receiving systemic antifungals from 12 centers in England were included. Data were collected prospectively during 26 consecutive weeks and entered into an online REDCap database. RESULTS: Two hundred eighty neonates and infants were included, the majority ≤1 month of age (68.2%). Prematurity was the commonest underlying condition (68.9%). Antifungals were prescribed for prophylactic reason in 79.6%; of those, 64.6% and 76.3% were extreme low birth weight infants and prematurely born neonates, respectively. Additional risk factors were present in almost all patients, but only 44.7% had ≥3 risk factors rendering them more susceptible to develop IC. Nonpremature and non extremely low birth weight premature infants only scored ≥3 risk factors in 32.6% and 15%, respectively. Fluconazole was the most common antifungal used (76.7% of all prescriptions), and commonly underdosed as treatment. The number of microbiological proven IC was low, 5.4%. CONCLUSIONS: Neonatal antifungal prophylaxis is commonly prescribed outside the recommendations based on known risk profiles. Fluconazole is the main antifungal prescribed in neonates and infants, with underdosing frequently observed when prescribed for treatment. Number of proven IC was very low. These observations should be taken into consideration to develop a national pediatric Antifungal Stewardship program aiming to guide rational prescribing.

Item Type: Article
Additional Information: This is a non-final version of an article published in final form in Ferreras-Antolín, L; Irwin, A; Atra, A; Dermirjian, A; Drysdale, SB; Emonts, M; McMaster, P; Paulus, S; Patel, S; Kinsey, S; et al. (2019) Neonatal Antifungal Consumption Is Dominated by Prophylactic Use; Outcomes From The Pediatric Antifungal Stewardship: Optimizing Antifungal Prescription Study. Pediatr Infect Dis J, 38 (12). pp. 1219-1223.
Keywords: 1114 Paediatrics And Reproductive Medicine, Pediatrics
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Pediatr Infect Dis J
ISSN: 1532-0987
Language: eng
Dates:
DateEvent
December 2019Published
16 September 2019Published Online
31 July 2019Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
MR/N006364/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
PubMed ID: 31568253
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111288
Publisher's version: https://doi.org/10.1097/INF.0000000000002463

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