title: Routine use of fluconazole prophylaxis in a neonatal intensive care unit does not select natively fluconazole-resistant Candida subspecies.
abstract: BACKGROUND
  We have previously demonstrated efficacy against fungal colonization and infection of fluconazole prophylaxis that was routinely administered since 2001 in our ICU for preterm infants <1500 g at birth (VLBW). With prolonged use, concerns exist for the emergence of acquired fungal resistance and of Candida subspecies that are natively fluconazole-resistant (NFR), mostly Candida glabrata and Candida krusei.
  
  
  METHODS
  We evaluated retrospectively all clinical and surveillance fungal isolates obtained from VLBW infants in our NICU during a 10-year period (1997-2006). Each fungal isolate was speciated, infants colonized or infected with NFR-Candida spp were identified and the incidence rates of colonization and infection by these fungal species were calculated. A comparison was made of the 6-year (2001-2006) prophylaxis period with the 4-year (1997-2000) preprophylaxis period.
  
  
  RESULTS
  Overall, colonization by NFR-Candida spp ranged between 2.8% and 6.6% of VLBW infants yearly admitted, without any increasing trend during the study period. There were 18 of 434 (4.1%) neonates colonized by these species. Five episodes of systemic fungal infections caused by NFR-Candida spp occurred (incidence rate, 1.1%). No significant differences were detected when compared with the preprophylaxis period, when 11 of 295 infants (3.7%) were colonized by NFR-Candida spp and 4 episodes of infection occurred (1.4%) (P = 0.84 and 0.76, respectively).
  
  
  CONCLUSIONS
  Fluconazole prophylaxis administered to VLBW neonates in 4- to 6-week courses after birth does not lead to the emergence of natively fluconazole-resistant Candida spp.
authors.affiliation: Neonatology and Hospital NICU, Azienda Ospedaliera Regina Margherita-S. Anna C. Spezia 60, 10136 Torino, Italy. paolomanzoni@hotmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Manzoni
authors.forename: Marialisa
authors.initials: M
authors.lastname: Leonessa
authors.forename: Paolo
authors.initials: P
authors.lastname: Galletto
authors.forename: Maria Agnese
authors.initials: MA
authors.lastname: Latino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Arisio
authors.forename: Milena
authors.initials: M
authors.lastname: Maule
authors.forename: Giovanni
authors.initials: G
authors.lastname: Agriesti
authors.forename: Luca
authors.initials: L
authors.lastname: Gastaldo
authors.forename: Elena
authors.initials: E
authors.lastname: Gallo
authors.forename: Michael
authors.initials: M
authors.lastname: Mostert
authors.forename: Daniele
authors.initials: D
authors.lastname: Farina
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects*; D002177:Candidiasis / Q000382:microbiology / Q000517:prevention & control*; D018890:Chemoprevention; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000382:microbiology / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D008826:Microbial Sensitivity Tests
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole