Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection.
OBJECTIVE
To evaluate the impact of selective fluconazole prophylaxis on incidence of invasive fungal infection and emergence of fluconazole resistance in neonatal intensive care.


METHODS
Retrospective study of very low birthweight (VLBW) babies (<1500 g birth weight) admitted to a neonatal intensive care unit (NICU) in the period 1 year before and after the implementation of an antifungal prophylaxis guideline.


METHODS
VLBW babies with an additional risk factor: colonisation of Candida species from surface sites with a central venous catheter; third generation cephalosporin treatment; or total duration of antibiotic treatment >10 days. Fluconazole protocol: Fluconazole 6 mg/kg for 3 weeks. Dose interval is every 72 h during the first 2 weeks of life. Thereafter, dose interval is reduced to every 48 h until 3 weeks old when daily fluconazole is given. Fluconazole is administered orally when enteral feeding achieved.


RESULTS
121 and 107 VLBW babies were admitted to the NICU in the year before and after the guideline was implemented, respectively. Data were available in 110 and 102 charts. 33/110 and 31/102 babies were eligible for fluconazole prophylaxis in the period before and after guideline implementation. 6/33 babies eligible for prophylaxis developed culture proven Candida sepsis before compared with no (0/31) babies after the guideline was implemented (p = 0.03). One baby (1/31) did develop probable Candida sepsis in the post guideline implementation period. During both study periods all Candida isolates remained fully susceptible to fluconazole.


CONCLUSIONS
Selective antifungal prophylaxis has reduced invasive fungal sepsis in one NICU without evidence of fluconazole resistance emerging.
McCrossan
Brian A
BA
Regional Neonatal Intensive Care Unit, Royal Maternity Hospital, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland, UK. brianmccrossan@doctors.org.uk
McHenry
Elaine
E
O'Neill
Fiona
F
Ong
Grace
G
Sweet
David G
DG
D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000517:prevention & control; D018890:Chemoprevention; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000627:therapeutic use*; D016469:Fungemia / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis
D000935:Antifungal Agents; D015725:Fluconazole