engleski

Micafungin for the treatment of suspected invasive candidiasis in neonates: experience from a tertiary centre in Croatia.

Background: The incidence of invasive candidiasis (IC) is substantial among neonates treated in intensive care units1 because these patients are frequently not immunocompetent, often require invasive procedures (e.g.central venous catheter [CVC] insertion, mechanical ventilation) and frequently receive broad- spectrum antibiotics, parenteral nutrition, histamine-2-receptor blockers and steroids.2 Mortality is considerably high (20–30%), with high rates of long-term neurodevelopmental impairment in survivors.1 Recent guidelines for the management of IC recommend an echinocandin as first-line treatment.3 The European Medicines Agency has approved micafungin as the only echinocandin for neonatal use. Material/methods: This retrospective, observational study was conducted in the Paediatric Intensive Care Unit of the University Hospital Centre Split, Croatia, to assess the safety of micafungin for the treatment of suspected IC in preterm- and term neonates in clinical practice. Conditions for suspected IC were unexplained fever, signs of sepsis or apnoea, need for increased respiratory support, hypotonia or lethargy, abdominal distention, receipt of broad- spectrum antibiotics, parenteral nutrition, CVC or other predisposing risk factors.4 Data from all eligible neonates were collected. Results: Between September 2014 and September 2015, micafungin monotherapy was administered for the treatment of 13 neonates with suspected IC. The mean (±standard deviation [SD]) gestational age was 32.77±5.8 weeks and mean (±SD) birth weight was 2170.77±1224.59 g. Five neonates had birth weight <1500 g. All neonates received broad- spectrum antibiotics ; the majority (11/13) were mechanically ventilated, 10/13 had a CVC and received total parenteral nutrition. At the time of micafungin administration, the mean (±SD) body weight was 2173.46±1214.21 g, mean (±SD) micafungin dose was 8.49±1.53 mg/kg, and mean (±SD) treatment duration was 11.92±7.15 days. Invasive Candida albicans infection was confirmed in one neonate from cultures of blood and cerebrospinal fluid. Fluconazole was added to the treatment regimen of this patient four days after micafungin. This patient had a favourable response to treatment, but had neurodevelopmental impairment. Among the 13 patients treated, five died and none of the deaths was deemed to be related to micafungin. No adverse drug reactions were reported and treatment interruption or discontinuation due to adverse events was not required. Elevation of liver enzymes, bilirubin and creatinine were not observed. Conclusions: Micafungin was well tolerated in neonates suspected of having IC. Treatment withdrawal because of adverse drug reactions was not observed. In addition to treating proven or suspected infections, micafungin may also be regarded as an attractive alternative to fluconazole for antifungal prophylaxis as it is active against fluconazole-resistant Candida and Aspergillus species.

invasive candidiasis; neonate; micafungin

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