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- ABCS: amphotericin B colloidal dispersion
- ABLC: amphotericin B lipid complex
- AmpB: amphotericin B
- CSF: cerebrospinal fluid
- DOL: day of life
- 5-FC: flucytosine
- GI: gastrointestinal
- VLBW: very low-birthweight (<1,500 g)
Objectives
After completing this article, readers should be able to:
Delineate the third most common cause of late-onset sepsis in very low-birthweight infants.
Describe the primary predictors for successful treatment of potential fungal sepsis and culture-positive sepsis.
List the gold standard for antifungal therapy in the neonate.
Compare and contrast liposomal amphotericin B and amphotericin B and describe the neonates in whom liposomal amphotericin B should be used.
Describe the situation in which antifungal prophylaxis may be appropriate.
Introduction
Among the 6,956 very low-birthweight (VLBW) (<1,500 g) infants reported to the National Institute of Child Health and Human Development between 1998 and 2000, Candida albicans was the third most frequent organism isolated (76/1313, 6%), following coagulase-negative Staphylococcus and S aureus, in episodes of late-onset sepsis. (1) Candida sp were responsible for 12.2% of first episodes of late-onset disease. (1) Because of a mortality rate as high as 25% (32% in the recent study by Stoll and associates (1)) for septicemia and 36% for meningitis as well as an 11-fold increase in the incidence of such infection over the previous 15 years, early initiation of therapy is imperative. (2)(3) Unfortunately, the mean delay between initial positive blood culture and commencement of antifungal treatment varies from 2.1±1.3 days to 5.1±3 days, and a significant number of infants are not diagnosed until autopsy. (4) Delayed treatment may reflect not only an increased risk of mortality, but also increased rates of intraventricular hemorrhage, chronic lung disease, retinopathy of prematurity requiring surgical therapy, and up to a fourfold increase in long-term neurodevelopmental delays. Early recognition and therapy as well as the removal of central lines remain the most important predictors of successful treatment. (5)
In a recent study by Rowen and colleagues (6) in which questionnaires were distributed to United States-based members of …
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