PEDIATRICS Vol. 117 No. 1 January 2006, pp. e22-e32 (doi:10.1542/peds.2004-2227)
ARTICLE |
Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study
a Neonatology and Hospital NICU
b Departments of Pathology
c Pediatric Sciences
d Clinical Pathology and Microbiology, Azienda Ospedaliera Regina Margherita-S. Anna, Torino, Italy
OBJECTIVE. Despite the promising preliminary results observed in extremely low birth weight (ELBW) populations, the use of fluconazole to prevent fungal colonization and infection in preterm neonates in the NICU is still an open question and not yet recommended as a standard of care. We have reviewed our 6-year series to assess the effectiveness and safety of this form of prophylaxis.
METHODS. This retrospective study consisted of 465 neonates who weighed <1500 g at birth and were admitted to our NICU in the period 1998–2003. Those who were born between 1998 and 2000 and did not receive fluconazole prophylaxis (group A, n = 240) were compared with those who were born between 2001 and 2003 and treated with fluconazole until the 30th day of life (45th for neonates <1000 g at birth; group B, n = 225). Weekly surveillance cultures were obtained from all patients. Incidence of fungal colonization, incidence of systemic fungal infection (SFI), rate of progression from colonization to infection, and mortality rates attributable to fungi were calculated for both groups and separately for neonates who were <1000 g (ELBW) and were 1001 to 1500 g (NE-VLBW) at birth.
RESULTS. Overall fungal colonization was significantly lower in group B (24.0%) than in group A (43.8%; relative risk [RR]: 0.406; 95% confidence interval [CI]: 0.273–0.605). The same was true of neonates with colonization in multiple sites (2.6% vs 5.8%) and of those with colonization from high-risk sites (5.8% vs 19.2%). SFI incidence was significantly lower in group B (10 of 225 cases; 4.4%) than in group A (40 of 240 cases; 16.7%; RR: 0.233; 95% CI: 0.113–0.447). Reduction of both colonization and SFI in group B was greater in the ELBW neonates and also significant in the NE-VLBW neonates. Rate of progression from colonization to infection was significantly lower in group B (0.17 vs 0.38; RR: 0.369; 95% CI: 0.159–0.815). Crude mortality rate attributable to Candida species was 1.7% (4 of 240) in group A vs 0% (0 of 225) in group B. Overall mortality rate (any cause before hospital discharge) was similar in the two groups (11.2% vs 10.6%), but in colonized infants (n = 159), it was significantly lower in group B (3.7% vs 18.1%; RR: 0.174; 95% CI: 0.039–0.778). The incidence of natively fluconazole-resistant fungal species did not increase over the years, and patterns of sensitivity to fluconazole remained the same. No adverse reaction related to fluconazole occurred.
CONCLUSIONS. Prophylactic fluconazole significantly reduces the incidence of colonization and systemic infection by Candida species in both ELBW and NE-VLBW neonates and decreases the rates of progression from initial colonization to massive colonization and to systemic infection. All VLBW neonates may benefit from fluconazole prophylaxis.
Key Words: fluconazole very low birth weight infant Candida infection colonization prophylaxis
Abbreviations: SFI—systemic fungal infection LOS—late-onset sepsis VLBW—very low birth weight ELBW—extremely low birth weight NE-VLBW—very low birth weight neonates, excluding ELBW neonates LAmB—liposomal amphotericin B dol, day of life RR—relative risk CI—confidence interval MIC—minimal inhibitory concentration
Accepted Jul 7, 2005.
![]()
CiteULike
Connotea
Del.icio.us
Digg
Facebook
Reddit
Technorati
Twitter What's this?
This article has been cited by other articles:
![]() |
C. M. Healy Fungal Prophylaxis in the Neonatal Intensive Care Unit NeoReviews, December 1, 2008; 9(12): e562 - e570. [Abstract] [Full Text] [PDF] |
||||
![]() |
F. H. Morriss Jr Adverse Medical Events in the NICU: Epidemiology and Prevention NeoReviews, January 1, 2008; 9(1): e8 - e23. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. A McCrossan, E. McHenry, F. O'Neill, G. Ong, and D. G Sweet Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F454 - F458. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Manzoni, I. Stolfi, L. Pugni, L. Decembrino, C. Magnani, G. Vetrano, E. Tridapalli, G. Corona, C. Giovannozzi, D. Farina, et al. A Multicenter, Randomized Trial of Prophylactic Fluconazole in Preterm Neonates N. Engl. J. Med., June 14, 2007; 356(24): 2483 - 2495. [Abstract] [Full Text] [PDF] |
||||
eLetters:
Read all eLetters
- Fluconazole antifungal prophylaxis - why is it necessary?
- David W Cartwright
- Pediatrics Online, 11 Jan 2006 [Full text]







