Oral amphotericin B for the prevention of Candida bloodstream infection in critically ill children.
OBJECTIVE
To determine the efficacy of oral amphotericin B for the prevention of Candida bloodstream infection in the pediatric intensive care unit.


METHODS
Retrospective, nonrandomized, historic-control study.


METHODS
Multidisciplinary pediatric intensive care unit at a university-affiliated children's medical center.


METHODS
Study group included all patients admitted to the pediatric intensive care unit from January 1, 1998, to December 31, 1999, who required mechanical ventilation and who were admitted for >7 days. The control group included all patients admitted for >7 days who needed mechanical ventilation from January 1, 1994, to December 31, 1997.


METHODS
Oral amphotericin B suspension, 50 mg every 8 hrs, administered to all study group patients soon after initiation of mechanical ventilation and terminating after weaning.


METHODS
The rates of Candida bloodstream infection were compared between the study and control groups.


RESULTS
Candida species were isolated from blood cultures in 5 of 185 (2.1%) and 21 of 196 (10.7%) patients in the study and control groups, respectively (p= .0038). There was also a statistically significant (p= .017) decrease in Candida bloodstream infection rate in all patients admitted to the pediatric intensive care unit for >7 days during the study period compared with the Candida bloodstream infection rate during the control period.


CONCLUSIONS
Prophylactic administration of oral amphotericin B may lead to a significant decrease in the rate of Candida bloodstream infection in ventilated pediatric intensive care unit patients.
Intensive Care Unit, Dana Children's Hospital, Tel-Aviv Souraski Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Josef
J
Ben-Ari
Zmira
Z
Samra
Elhanan
E
Nahum
Izhak
I
Levy
Shai
S
Ashkenazi
Tommy M
TM
Schonfeld
D000284:Administration, Oral; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002177:Candidiasis / Q000517:prevention & control*; D002648:Child; D016638:Critical Illness; D003428:Cross Infection / Q000517:prevention & control; D016469:Fungemia / Q000517:prevention & control*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D012121:Respiration, Artificial; D012189:Retrospective Studies
D000935:Antifungal Agents; D000666:Amphotericin B