title: Antifungal prophylaxis to prevent neonatal candidiasis: a survey of perinatal physician practices.
abstract: BACKGROUND
  Bloodstream infections with Candida species have a high mortality rate in very low birth weight infants. Preliminary data suggest that prophylaxis with fluconazole reduces the incidence of colonization and invasive Candida infections in high-risk, very low birth weight neonates. The extent of antifungal prophylaxis use to prevent neonatal candidemia is unknown.
  
  
  METHODS
  We surveyed a 20% random sample of the members of the American Academy of Pediatrics Section on Perinatal Pediatrics. We collected information on prophylactic agents used, indications for use, and rationale for reported practices.
  
  
  RESULTS
  A total of 219 (47%) of 469 members sampled responded; 3 clinicians who did not provide care to very low birth weight infants were excluded. Antifungal prophylaxis use was reported by 73 (34%) respondents. Agents used included intravenous fluconazole (66%), oral nystatin (59%), and intravenous amphotericin B (21%). Decreased birth weight or early gestational age was the most frequent indication to start prophylaxis (57 [78%]). Respondents who did not use antifungal prophylaxis compared with respondents who used fluconazole prophylaxis were significantly more likely to have concerns about (1) the emergence of antifungal resistance, (2) unclear criteria on which to base the decision to start prophylaxis, and (3) the need for clarification of the role of surveillance cultures.
  
  
  CONCLUSIONS
  Although preliminary data suggest that fluconazole is efficacious to prevent candidemia in a subset of neonates, this practice is not used widely by clinicians who care for very low birth weight infants. Additional efficacy studies should address the emergence of antifungal resistance or clarification of criteria to initiate prophylaxis, including the role of surveillance cultures.
authors.affiliation: Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. lburwell@ph.lacounty.gov
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Burwell
authors.forename: David
authors.initials: D
authors.lastname: Kaufman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blakely
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000517:prevention & control*; D003657:Decision Making; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D010500:Perinatology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000935:Antifungal Agents