BOSTON – Preventive antifungal therapy and changes in broad-spectrum antibiotic use were associated with a significant decrease in the incidence of invasive candidiasis in neonatal intensive care units.
As these changes took place in a large group of neonatal intensive care units, Candida infections dropped from 4 to 1 per 1,000 patients. In the smallest infants – those weighing less than 750 grams – incidence dropped from 83 to 24 per 1,000, Dr. Sofia Aliaga said at the annual meeting of the Pediatric Academic Societies.
Dr. Aliaga, a neonatologist at the University of North Carolina at Chapel Hill, and her colleagues used a large administrative database to determine the incidence of invasive candidiasis over a 14-year period (1997-2010). In addition to disease incidence, they looked at changes in both antifungal prophylaxis and empirical treatment, and the use of broad-spectrum antibiotics in the NICUs.
The database contained information on 709,325 infants seen at 322 units, all of which were managed by a single medical group. There were 2,101 episodes of invasive candidiasis in 2,063 infants.
The researchers divided the cohort into four groups by weight: less than 750 g, 750-999 g, 1,000-1,499 g, and 1,500 g or heavier.
Over the study period, antifungal prophylaxis increased significantly among the smallest babies, from 4 to 119 admissions per 1,000. At the same time, empirical antifungal therapy for these infants also increased, from 4 to 11 admissions per 1,000 overall. The biggest change with empirical therapy occurred in the smallest babies, increasing from 4 to 111 per 1,000.
Finally, the units decreased their use of broad-spectrum antibiotics for all admissions. Use fell from 276 to 48 admissions per 1,000. This change was seen across all weight groups.
The incidence of invasive candidiasis fell from 4 to 1 per 1,000 admissions. The greatest decrease occurred among babies weighing less than 750 g. In this group, the infection fell from 83 to 24 per 1,000.
Overall changes in NICU management also might have influenced the incidence of candidiasis, Dr. Aliaga acknowledged.
"During this time, there was a big push to do quality improvement projects with central line catheters to decrease infection rates ... Babies in the NICU also spend a lot less time on ventilators now than they did 10 years ago, so with less time with an endotracheal tube there are fewer ventilator-associated infections. But I do think the decrease in disease we’re seeing is real, and related to the changes we have made."
Dr. Aliaga said she had no relevant financial disclosures.