Arun Sumitha, Varghese Mereta, Cherian Taliya, Ramaswami Prakash
Neonatology, Believers Church Medical College Hospital, Thiruvalla, IND.
Biostatistics, Christian Medical College Vellore, Vellore, IND.
Cureus. 2023 Mar 14;15(3):e36136. doi: 10.7759/cureus.36136. eCollection 2023 Mar.
Background Prophylactic antifungals are often used in high-risk babies in neonatal intensive care units (NICUs) to reduce invasive fungal infections (IFIs). However, existing guidelines regarding prophylactic antifungal usage do not clearly define the high-risk population. This study aimed to assess the practices related to prophylactic antifungal use in NICUs in India. Methods For this cross-sectional study, an online structured questionnaire was completed by neonatologists who worked in level 3 NICUs in 12 states in India during the period June 2022 to August 2022. Results Data from 151 NICUs were analyzed. 71.7% of respondents were from private hospitals, and 28.3% were from government hospitals. Nearly one-fourth of the units (28.5%) used antifungal prophylaxis in all extremely low birth weight (ELBW) babies, while another one-fourth (25.8%) used a case-based approach. The remaining NICUs (45.7%) did not use prophylactic antifungals. Among the users, the preferred antifungal was fluconazole; 3 mg/kg and 6 mg/kg were the dosage regimens used. The commonly used interval for administering fluconazole was 72 hours (69.2% of units). The intravenous route was the preferred route of administration (84.1%). Factors that influenced the non-users were the low incidence of fungal infections in their NICUs and concern about the development of resistance. It was noted that the users felt strongly about the need for further recommendations from pediatric societies and more studies on the efficacy of antifungals. Conclusion There is considerable variation in the use of prophylactic antifungals across NICUs in India. Among the users, uniformity in the choice of antifungal and interval of administration was observed. Further recommendations from pediatric societies, including the definitions of neonates at-risk of fungal infections, are required to ensure consistency in practice and help clinicians decide whether or not to use prophylactic antifungals.
背景 预防性抗真菌药物常用于新生儿重症监护病房（NICU）中的高危婴儿，以减少侵袭性真菌感染（IFI）。然而，现有的预防性抗真菌药物使用指南并未明确界定高危人群。本研究旨在评估印度NICU中预防性抗真菌药物的使用情况。方法 对于这项横断面研究，在2022年6月至2022年8月期间，由在印度12个邦的三级NICU工作的新生儿科医生完成一份在线结构化问卷。结果 分析了来自151个NICU的数据。71.7%的受访者来自私立医院，28.3%来自公立医院。近四分之一的单位（28.5%）对所有极低出生体重（ELBW）婴儿使用抗真菌药物进行预防，另有四分之一（25.8%）采用基于病例的方法。其余的NICU（45.7%）未使用预防性抗真菌药物。在使用者中，首选的抗真菌药物是氟康唑；使用的剂量方案为3mg/kg和6mg/kg。氟康唑常用的给药间隔为72小时（69.2%的单位）。静脉途径是首选的给药途径（84.1%）。影响非使用者的因素是其NICU中真菌感染的发生率低以及对耐药性发展的担忧。值得注意的是，使用者强烈认为需要儿科协会提供进一步的建议以及更多关于抗真菌药物疗效的研究。结论 印度各NICU在预防性抗真菌药物的使用上存在很大差异。在使用者中，观察到抗真菌药物的选择和给药间隔具有一致性。需要儿科协会提供进一步的建议，包括对有真菌感染风险的新生儿的定义，以确保实践的一致性，并帮助临床医生决定是否使用预防性抗真菌药物。
