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OASCN Resources | Fungal Sepsis Prophylaxis, Diagnosis and Management

These resources were developed by the OASCN Collaborative between 2021-2022.

Relevant Didactics:

Relevant Learning Points:

Learning Point #15: True “asymptomatic” candidemia is very rare and only if workup is completely negative, there are no clinical concerns, and repeat culture off antibiotics is also negative.

Learning Point #16: Modern systems will identify C. albicans in a mean of 25-36 hours. “Fungal culture” is not needed. Discontinue antibacterials if fungal diagnosis is clear.

Learning Point #17: Fluconazole and amphotericin are first line therapies; micafungin is acceptable if no renal/CNS disease. Double coverage is not necessary. Fluconazole resistance to C. glabrata and C. krusei is a problem so check the species result.

  • Ampho B is well tolerated in babies and provides broader coverage than fluconazole. Its use with pre-existing thrombocytopenia is OK.
  • Treatment for 2 weeks from last positive culture is sufficient for non-meningitic disease.
  • Larger doses of micafungin are needed for newborns due to enhanced clearance. Anidulafungin is fine if that is the echinocandin on your formulary.

Relevant References: 

Ericson JE et al. Fluconazole prophylaxis for the prevention of candidiasis in premature infants: a meta-analysis using patient-level data. Clin Infect Dis 2016;63:604.

Leonart LP et al. Fluconazole doses used for prophylaxis of invasive fungal infection in neonatal intensive care units: a network meta-analysis. J Pediatr 2017;185:129.

Cohen JF et al. Diagnostic accuracy of serum (1,3)-beta-d-glucan for neonatal invasive candidiasis: systematic review and meta-analysis. Clin Microbiol Infect 2020;26:291.

Scott BL et al. Pharmacokinetic, efficacy, and safety considerations for the use of antifungal drugs in the neonatal population. Exp Opin Drug Metabol Tox 2020;7:605-