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5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Dragana Janic Antifungals and current treatment guidelines in pediatrics and neonatology Dragana Janic. University Children`s Hospital, Belgrade, Serbia 10/10/17 Hotel Crowne Plaza, Belgrade, Serbia; www.dtfd.org www.fems-microbiology.org 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates • Infectious Diseases Society of America (IDSA), 2016 Pappas PG et al. Clinical practice guidelines for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4) • The European Conference on Infection in Leukaemia (ECIL-4), 2014 Groll AH et al. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. Lancet Oncol. 2014 Jul;15(8):e327-40 • The European Society of Clinical Microbiology and Infectious Diseases (ESCMID), 2012 Hope WW et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect. 2012 Dec;18 Suppl 7:38-52 Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy (DMyKG), 2011 Ruhnke M et al. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses. 2011 Jul;54(4):279-310 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Characteristics of the guidelines ESCMID ECIL All children IFI in pediatric hematological and Only candida oncological patients A B C / I II III + D supports A B C / I II III recommendation against use IDSA DMyKG Neonates All children A B C / I II III Only candida A B C / I II III Tragiannidis A et al.Invasive candidiasis and candidemia in neonates and children update on current guidelines. Mycoses. 2015; 58:10-21 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Candida IFI facts • 10% nosocomial BSIs, 50% of CVC infections, 50% non- albicans spp, 1.5 to 5 times more prevalent in children than in adults, mortality 50% in neonates, frequent meningoencephalitis in neonates • Susceptibility: C. albicans, C. parapsilosis, C. tropicalis to Fluconasole and other azoles, AMB and echinocandines • Resistance: C. crusei and C. glabrata to fluconazole and variably to other azoles • Emerging: C. parapsilosis (neonatal patogen) resistance to fluconazole • Far less prevalent C. guillermondi to echinocandines, C. lusitaniae to AMB 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Candida IFI diagnosis • IDSA (neonates) • CSF + dilated retinal exam in pts with + BC and/or urinoculture B-III • Imaging of liver, spleen and GU tract in case of persistently + cultures from sterile body fluids A-III • Meningoencephalitis often, also liver, spleen, joints, eye, lungs • Septic shock NO • ESCMID, ECIL, DMyKG • Culture/microscopic exam, susceptibility testing YES • Non/culture assays NO • Search for endocarditis, endophtalmitis, chorioretinitis 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Treatment of IC: D-AMB, L-AMB and ABLC ESCMID ECIL D-AMB: C-I D-AMB: / L-AMB: A-I L-AMB: / ABLC: B-II ABLC: C-II IDSA DMyKG D-AMB: A-I D-AMB: C-III L-AMB: A-I L-AMB: A-I ABLC: / ABLC: A-II . 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Treatment of IC: caspofungin, micafungin and anidulafungin ESCMID ECIL caspofungin : A-I caspofungin : B-II micafungin : A-I micafungin : B-II anidulafungin: B-II anidulafungin: / IDSA DMyKG caspofungin : A-I/A-III* caspofungin : A-II micafungin : A-I/A-III* micafungin : A-I anidulafungin: / anidulafungin: / * First choice for C. glabrata 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Treatment of IC: fluconazole and voriconazole ESCMID ECIL fluconazole: B-I fluconazole: B-II voriconazole : B-I voriconazole: B-II IDSA DMyKG fluconazole: A-I/A-III* fluconazole: A-II voriconazole: A-I voriconazole : A-II * First choice for C. parapsilosis 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Treatment of IC in neonates: D-AMB, L-AMB, ABLC and ABCD ESCMID D-AMB: B-II L-AMB: B-II ABLC: C-II ABCD: / IDSA DMyKG D-AMB: A-II D-AMB: C-III L-AMB: B-III L-AMB: A-II ABLC: B-III ABLC: A-II ABCD: B-III ABCD: / 5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES Training Course for Fungal Infections in Neonates Treatment of IC in neonates: caspofungin and micafungin, fluconazole ESCMID Flucytosine combination with L- AMB or fluconazole for caspofungin: C-II meningoencephalitis in IDSA and micafungin: B-II DMyKG C-III fluconazole B-II IDSA DMyKG caspofungin: / caspofungin: A-II micafungin: B-III micafungin: A-II fluconazole B-II fluconazole B-II

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5th DIAGNOSIS AND THERAPY OF FUNGAL DISEASES. Training Course for Fungal Infections in Neonates. 10/10/17 Hotel Crowne Plaza, Belgrade, Serbia; www.dtfd.org www.fems-microbiology.org. Antifungals and current treatment guidelines in pediatrics and neonatology. Dragana Janic. University

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