ArticleJournal of perinatology : official journal of the California Perinatal Association2009
Refractory neonatal candidemia and high-dose micafungin pharmacotherapy.
Article in Journal of perinatology : official journal of the California Perinatal Association, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
10 citing papers in PubMed, 31 citations in OpenAlex.
- Emerging Treatments in Neonatal Fungal Infections: Progress and Prospects.Paediatric drugs · 2025Review
- Risk Factors, Diagnosis, and Treatment of Neonatal Fungal Liver Abscess: A Systematic Review of the Literature.Life (Basel, Switzerland) · 2023Review
- Persistent candidemia in very low birth weight neonates: risk factors and clinical significance.BMC infectious diseases · 2018Article
- Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data.BioMed research international · 2017Article
- Epidemiology of and risk factors for neonatal candidemia at a tertiary care hospital in western China.BMC infectious diseases · 2016Article
- Pharmacokinetics and pharmacodynamics of antibacterials, antifungals, and antivirals used most frequently in neonates and infants.Clinical pharmacokinetics · 2014Review
- Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization.Journal of perinatology : official journal of the California Perinatal Association · 2012Article
- Neonatal intensive care unit candidemia: epidemiology, risk factors, outcome, and critical review of published case series.Mycopathologia · 2012Article
- The use of antifungal therapy in neonatal intensive care.Clinics in perinatology · 2012Review
- Safety of micafungin in infants: insights into optimal dosing.Expert opinion on drug safety · 2011Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivePreterm neonates with candidemia frequently have persistently positive blood cultures, despite the use of conventional antifungal therapy. Our institutional treatment protocol for invasive candidiasis incorporates lipid complex amphotericin B as initial therapy with the sequential addition of fluconazole and high-dose micafungin (10 mg kg(-1)) every 48 to 72 h, if cultures from a sterile site remain positive. Our study objectives were to compare the clinical profiles and outcomes of preterm neonates with candidemia that responded to or were refractory to conventional antifungals. We further evaluate the clinical efficacy of high-dose micafungin pharmacotherapy of refractory candidemia. STUDY
designA chart review was performed on preterm infants (n=29) with invasive candidiasis and demographic, microbiologic and outcome data abstracted. Proportions and continuous variables were compared between the groups using Fisher's exact two-tailed test and t-test.
resultThe refractory (n=19) candidemia and early responder (n=10) groups had comparable mean (+/-s.d.) gestation, 27(+/-3.1) vs 27.8 (+/-2.7) weeks. The refractory group was administered antibiotics for a longer duration, 14.5 (+/-10.3) vs 7.1 (+/-5) days, had a preponderance of non-albicans infections, 11 (57.9%) vs 1 (10%) and were on enteral feeds > 20 ml kg(-1) day(-1) significantly less often (21 vs 70%). Mortality was significantly higher (53 vs 20%) and fungal clearance rates lower (63.1 vs 90%), with a longer duration to clearance in the group with refractory candidemia. Mean aspartate aminotransferase (AST) showed a statistically significant increase following micafungin treatment, although clinical significance remains unclear.
conclusionCandidemia refractory to conventional antifungals is associated with prolonged antibiotic use, lack of enteral nutritive feeds and non-albicans infection. Despite high-dose micafungin pharmacotherapy in combination with conventional antifungals, infants with refractory candidemia had high mortality and poor fungal clearance.
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