Fluconazole prophylaxis: can we eliminate invasive Candida infections in the neonatal ICU?
OBJECTIVE
Owing to the high mortality, risk of neurodevelopmental impairment and end-organ involvement with fungal infections in the neonate, prevention of invasive Candida infections in extremely preterm infants should be a priority for each neonatal ICU.


RESULTS
Even with prompt or empiric treatment, mortality and neurodevelopmental impairment is high (57%) in infants <1000 g. Multiple studies have been performed with fluconazole prophylaxis, including a recent multicenter randomized controlled trial. All of the studies have demonstrated efficacy and safety with no increase or emergence of fungal resistance. Analysis of these studies demonstrates that fluconazole prophylaxis decreased the incidence of invasive Candida infections in high-risk infants <1000 g by 91% (P = 0.0004) and all infants <1500 g by 85% (P < 0.0001). The mortality rate from all causes was 25% lower (P = 0.029). Furthermore, studies have demonstrated that all Candida-related mortality can be eliminated in an entire neonatal ICU by targeting fluconazole prophylaxis in infants <1000 g.


CONCLUSIONS
Targeting fluconazole prophylaxis to infants who are either <1000 g or < or =27 weeks is highly effective, safe and inexpensive, and can eliminate these infections as a cause of neurodevelopmental impairment and mortality.
Kaufman
David A
DA
Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA. dak4r@virginia.edu
D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000517:prevention & control*; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D015725:Fluconazole