Antifungal Drug Usage in European Neonatal Units: A Multicenter Weekly Point Prevalence Study

• Published in: The Pediatric infectious disease journal
• Main Authors: Chorafa, Elisavet, Iosifidis, Elias, Oletto, Andrea, Warris, Adilia, Castagnola, Elio, Bruggemann, Roger, Groll, Andreas H, Lehrnbecher, Thomas, Ferreras Antolin, Laura, Mesini, Alessio, Agakidou, Eleni, Controzzi, Tiziana, De Luca, Maia, Dimitriou, Gabriel, Emonts, Marieke, Esposito, Susanna, Fernàndez-Polo, Aurora, Ghimenton-Walters, Elisabetta, Gkentzi, Despoina, Grasa, Carlos, Hatzidaki, Eleftheria, Jõgi, Piia, Kildonaviciute, Kornelija, Kontou, Angeliki, Leibold-Aguinarte, Alessa, Manzanares, Angela, Mendoza-Palomar, Natalia, Metsvaht, Tuuli, Noni, Maria, Paulus, Stéphane, Perrone, Serafina, Rincón-López, Elena, Romani, Lorenza, Sánchez, Laura, Cetin, Benhur Sirvan, Spoulou, Vana, Strenger, Volker, Vergadi, Eleni, Villaverde, Serena, Vuerich, Marco, Zamora-Flores, Elena, Roilides, Emmanuel
• Format: Journal Article
• Language: English
• Published: United States 25.06.2024
• ISSN: 1532-0987
• DOI: 10.1097/INF.0000000000004445

Data on antifungal prescribing in neonatal patients are limited to either single-center or single-country studies or to 1-day recording. Therefore, we assessed antifungal longitudinal usage in neonatal units (NUs) within Europe. CALYPSO, a prospective weekly point prevalence study on antifungal drug usage in NUs in 18 hospitals (8 European countries), was conducted in 2020 during a 12-week period. All patients receiving systemic antifungals were included. Ward demographics were collected at the beginning; ward and patient data including indication, risk factors and antifungal regimen were weekly collected prospectively. Among 27 participating NUs, 15 (56%) practiced antifungal prophylaxis for neonates with birth weight <1000 g or <1500 g and additional risk factors. In total, 174 patients received antifungals with a median frequency per week of 10.5% ranging from 6.9% to 12.6%. Indication for antifungal prescribing was prophylaxis in 135/174 (78%) courses and treatment in 22% [39 courses (69% empirical, 10% preemptive, 21% targeted)]. Fluconazole was the most frequent systemic agent used both for prophylaxis (133/135) and treatment (15/39, 39%). Among neonates receiving prophylaxis, the most common risk factors were prematurity (119/135, 88%), mechanical ventilation (109/135, 81%) and central vascular catheters (89/135, 66%). However, gestational age <28 weeks was only recorded in 55/135 (41%) courses and birth weight <1000 g in 48/135 (35%). Most common reason for empirical treatment was late-onset sepsis; all 8 targeted courses were prescribed for invasive candidiasis. Antifungal usage in European NUs is driven by prophylaxis and empirical treatment with fluconazole being the most prescribed agent for both indications.