Feature Article—Continuing Medical Education Oral amphotericin B for the prevention of Candida bloodstream infection in critically ill children* Josef Ben-Ari, MD; Zmira Samra, PhD; Elhanan Nahum, MD; Izhak Levy, MD, Shai Ashkenazi, MD; Tommy M. Schonfeld, MD C andida bloodstream infection (CBSI) is becoming an in- creasingly important nosoco- mial infection (1, 2). Candida species is the fifth most common cause of bloodstream infections among patients in pediatric intensive care units (PICUs) (2– 4). The rate of CBSI among patients in the PICU has been reported to be 0.2% to 4.3% (2–5). The National Epidemiology of Mycosis Survey (or NEMIS) showed that the average rate of CBSI is 0.98% in ICU patients, and there are wide interin- stitutional variations, from 0.29% to 2% (6, 7). CBSI accounted for 4.9 –9.3% of all blood stream infections in PICUs (3, 4, 8). Nosocomial CBSI is associated with in- creased morbidity and mortality during hospitalization compared with other non- fungal bloodstream infections (8 –10). This is especially true for patients who *See also p. 184. Director, Intensive Care Unit, Dana Children’s Hospital, Tel-Aviv Souraski Medical Center, Sackler School of Medi- cine, Tel-Aviv University, Tel Aviv, Israel (JB-A); Director, Microbiology Department, Rabin Medical Center, Tikva, Israel (ZS); Senior Pediatric Intensivist, Pediatric Intensive Care Unit (EN), Consultant, Pediatric Infectious Disease Unit (IL), Direc- tor, Pediatric Intensive Care Unit (TMS), Schneider Children’s Medical Center of Israel, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel (EN); Director, Pediatrics A, Schneider Children’s Hospital, Tikva, Israel (SA). Copyright © 2006 by the Society of Critical Care Medicine and the World Federation of Pediatric Inten- sive and Critical Care Societies DOI: 10.1097/01.PCC.0000200946.30263.B6 LEARNING OBJECTIVES On completion of this article, the reader should be able to: 1. Identify the role of the length of intensive care unit stay in the development of Candida bloodstream infection in critically ill infants and children. 2. Identify the important sites for Candida colonization and their relationship to Candida bloodstream infection in the pediatric intensive care unit. 3. Understand the role of oral Amphotericin B treatment in the prevention of Candida bloodstream infections in critically ill infants and children. All authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity. Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity. Visit the Pediatric Critical Care Medicine Web site (www.pccmjournal.org) for information on obtaining continuing medical education credit. Objectives: To determine the efficacy of oral amphotericin B for the prevention of Candida bloodstream infection in the pediatric intensive care unit. Design: Retrospective, nonrandomized, historic-control study. Setting: Multidisciplinary pediatric intensive care unit at a university-affiliated children’s medical center. Patients: Study group included all patients admitted to the pediatric intensive care unit from January 1, 1998, to December 31, 1999, who required mechanical ventilation and who were admitted for >7 days. The control group included all patients admitted for >7 days who needed mechanical ventilation from January 1, 1994, to December 31, 1997. Interventions: Oral amphotericin B suspension, 50 mg every 8 hrs, administered to all study group patients soon after initiation of mechanical ventilation and terminating after weaning. Measurements: The rates of Candida bloodstream infection were compared between the study and control groups. Main Results: Candida species were isolated from blood cultures in 5 of 185 (2.1%) and 21 of 196 (10.7%) patients in the study and control groups, respectively (p  .0038). There was also a statisti- cally significant (p  .017) decrease in Candida bloodstream infec- tion rate in all patients admitted to the pediatric intensive care unit for >7 days during the study period compared with the Candida bloodstream infection rate during the control period. Conclusion: Prophylactic administration of oral amphotericin B may lead to a significant decrease in the rate of Candida blood- stream infection in ventilated pediatric intensive care unit pa- tients. (Pediatr Crit Care Med 2006; 7:115–118) KEY WORDS: candidemia; Candida; amphotericin B; pediatric intensive care unit; preventive; nosocomial 115 Pediatr Crit Care Med 2006 Vol. 7, No. 2