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-
616.
