title: Empiric antifungal therapy and outcomes in extremely low birth weight infants with invasive candidiasis.
abstract: OBJECTIVE
  To assess the impact of empiric antifungal therapy for invasive candidiasis on subsequent outcomes in premature infants.
  
  
  METHODS
  This was a cohort study of infants with a birth weight ≤ 1000 g receiving care at Neonatal Research Network sites. All infants had at least one positive culture for Candida. Empiric antifungal therapy was defined as receipt of a systemic antifungal on the day of or the day before the first positive culture for Candida was drawn. We created Cox proportional hazards and logistic regression models stratified on propensity score quartiles to determine the effect of empiric antifungal therapy on survival, time to clearance of infection, retinopathy of prematurity, bronchopulmonary dysplasia, end-organ damage, and neurodevelopmental impairment (NDI).
  
  
  RESULTS
  A total of 136 infants developed invasive candidiasis. The incidence of death or NDI was lower in infants who received empiric antifungal therapy (19 of 38; 50%) compared with those who had not (55 of 86; 64%; OR, 0.27; 95% CI, 0.08-0.86). There was no significant difference between the groups for any single outcome or other combined outcomes.
  
  
  CONCLUSIONS
  Empiric antifungal therapy was associated with increased survival without NDI. A prospective randomized trial of this strategy is warranted.
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Greenberg
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Miller
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Auten
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Kennedy
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Duara
authors.forename: Kurt
authors.initials: K
authors.lastname: Schibler
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Frantz
authors.forename: Dale L
authors.initials: DL
authors.lastname: Phelps
authors.forename: Brenda B
authors.initials: BB
authors.lastname: Poindexter
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Watterberg
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents