ORIGINAL ARTICLE

Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection

Brian A McCrossan¹, Elaine McHenry², Fiona O’Neill³, Grace Ong², David G Sweet¹

¹ Regional Neonatal Intensive Care Unit, Royal Maternity Hospital, Belfast, Northern Ireland, UK
² Department of Microbiology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
³ Department of Pharmacy, Royal Victoria Hospital, Belfast, Northern Ireland, UK

Dr Brian A McCrossan, Regional Neonatal Intensive Care Unit, Royal Maternity Hospital, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland, UK; brianmccrossan{at}doctors.org.uk

Objectives: To evaluate the impact of selective fluconazole prophylaxis on incidence of invasive fungal infection and emergence of fluconazole resistance in neonatal intensive care.

Design: 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.

Patients: 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.

Abbreviations: ELBW, extremely low birth weight; NICU, neonatal intensive care unit; VLBW, very low birth weight

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