A Quality Improvement Initiative To Reduce Invasive Candidiasis In Extremely Low Birth Weight Neonates
DOI:
https://doi.org/10.51253/pafmj.v74i1.9446Keywords:
Candidiasis, Antifungal agents, Intensive care units\, Infant, Newborn, Very low birth weight, Length of stayAbstract
Objective: To evaluate the impact of a quality improvement (QI) initiative, which included a Fluconazole prophylaxis protocol and provider education on neonatal Candidiasis.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Neonatal Intensive Care Unit (NICU), Aga Khan University, Karachi Pakistan, from Apr 2015 to Dec 2019.
Methodology: All extremely low birth weight neonates (ELBW) neonates admitted to the NICU between April 2015 and March 2017 were included in the pre-implementation phase. All ELBW neonates admitted between April 2017 and December 2019 were included in the post-implementation phase. Data were collected from medical records. The primary outcome was the frequency of Invasive Candidiasis (IC) before and after the QI initiative.
Results: Altogether, 272 neonates were included in the study, with 115 neonates in the Pre-Implementation Group and 157 neonates in the Post-Implementation Group. The frequency of IC was 6(5.2%) in the pre-implementation and 1(0.6%) in the post-implementation period, (p=0.044). Candida parapsilosis 2(40%) and Candida glabrata 2(40%) were the organisms most commonly isolated from blood cultures. All organisms were sensitive to Fluconazole in both the pre-and post-implementation
cohorts. There was no difference in mortality (54(50.5%) vs. 69(44.2%), p=0.32) or length of stay (19.6±13.3 vs. 23.4±18.4 days,p=0.061) before and after Fluconazole prophylaxis.
Conclusion: The frequency of invasive Candidiasis in ELBW neonates was successfully reduced by introducing a Fluconazole prophylaxis protocol in the NICU as a QI initiative. A team-based approach and provider education ensured high compliance.
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