Background

Knowledge of antifungal prescribing in neonatal units is extremely important. However, data on antifungal use in neonatal inpatients across Europe are limited. There is need to collect standardized multi-center data. We organized a European 12-wk modified point-prevalence study (mPPS) to record antifungal consumption in neonates and infants.

Methods

All patients hospitalized in neonatal units (NUs) and receiving systemic antifungals of 17 hospitals across Europe were included. Information about ward demographics was collected once at the beginning; weekly ward and patient data were collected prospectively for the 12-wk study period and entered in REDCap database.

Results: 26 NUs (4 Level 1, 4 Level 2, 18 Level 3) from 17 hospitals, located in 8 European countries with a median capacity of 21 beds participated in the study.

Results

The median percentage of neonates receiving antifungal agents per mPPS week across all NUs Level 3 was 9.6% (range 7.5-11.4). A total of 167 patients were included in the study; 156 patients aged ≤90d (median age=7 days, Q1=3,Q3=20.5d) and 11 aged 3-60 months (median age=4 months, Q1=3,Q3=5.5mo). Prematurity was most common underlying condition among patients ≤90d (86%), whereas chronic respiratory disease (64%) and history of surgery (36%) were among patients 3-60 months.Indication for antifungal prescribing at inclusion was prophylaxis in 77% and treatment in 23%.

Conclusions

Fluconazole was the most frequently prescribed agent both for prophylaxis (98%, N=129) and treatment (39%, N=38). The most common reasons for prophylaxis were prematurity, birth weight <1000g and central venous catheters; whereas for empirical treatment, it was late onset sepsis.

Conclusions: The majority of antifungal prescriptions across European NUs is for prophylaxis. Results from this multicenter study can be a first step to guide a European antifungal stewardship program.