Fluconazole Prophylaxis 2

Healy CM, Baker CJ, Zaccaria E, et al. Impact of Fluconazole Prophylaxis on Incidence and Outcome of Invasive Candidiasis in a Neonatal Intensive Care Unit. J Pediatr (Aug 2005); 147:166-171.

Objectives. We assessed the impact of intravenous fluconazole prophylaxis (FP) in extremely low birth weight (ELBW [<1000 g]) infants on the incidence of and outcome from invasive Candidiasis (IC) in all infants admitted to a neonatal intensive care unit (NICU).

Study design. Beginning April 1, 2002, FP was given to ELBW infants aged < 5 days admitted to the NICU of Woman's Hospital of Texas. Infants in NICU in whom IC developed during the first 2 years of FP (FP period) were compared with those with IC during 2000–2001.

Results. During 2000–2001 and the FP period, the incidence of IC in ELBW infants decreased from 7% (15 of 206) to 2% (5 of 240) (P=.01), and the IC-related mortality rate decreased from 12% (4 of 33) to 0 (0 of 40) (P=.04); the incidence of IC increased from 0.1% (4 of 2806) to 0.2% (8 of 3372) in infants of birth weight ≥ 1000 g (P=.06), and no IC-related deaths occurred. During the FP period, IC developed in older infants (24 vs. 12 days; P=.12) who had similar risk factors for IC.

Conclusion. Invasive Candidiasis occurred in our NICU in spite of FP and shifted to bigger, more mature infants who had a better outcome.

Comments. Fluconazole prophylaxis to prevent Candidemia in ELBW infants is highly controversial. I am aware as several NICUs that are currently using this strategy, and all are seeing dramatic reductions in invasive Candida infections in this population. Those who oppose this strategy site concerns about possible untoward effects of fluconazole, and the potential emergence of resistant Candida species. To date, none of the reported studies in this population have seen either of these problems. Other infection control measures to minimize the rate of fungal infections include:

If you are struggling with a high fungal infection rate (>5-6%) despite working on these practices, then you may want to consider giving fluconazole prophylaxis a try. For more on this topic, see 2-002). ABK

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