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

Brian A McCrossan ^1*, Elaine McHenry ², Fiona O'Neil ², Grace Ong ² and David G Sweet ¹

¹ Royal Maternity Hospital, Belfast, United Kingdom
² Royal Victoria Hospital, Belfast, United Kingdom

^* To whom correspondence should be addressed. E-mail: brianmccrossan{at}doctors.org.uk.

Accepted 9 April 2007

Abstract

Objectives:Evaluate impact of selective fluconazole prophylaxis on incidence of invasive fungal infection and emergence of fluconazole resistance in Neonatal Intensive Care (NICU).

Design:Retrospective study of babies < 1500g birth weight (VLBW) admitted to NICU in a period 1 year before and after implementation of an antifungal prophylaxis guideline.

Patients:Eligibility: VLBW babies with an additional risk factor: (1) Colonization of candida species from surface sites with a central venous catheter, (2) 3rd generation Cephalosporin treatment or (3) total duration of antibiotic therapy >10 days.

Fluconazole Protocol:Fluconazole 6mg/kg for 3 weeks. Dose interval every 72 hours during the first 2 weeks of life. Thereafter, dose interval reduced to 48 hourly until 3 weeks old when daily fluconazole is given. Fluconazole administered orally when enteral feeding achieved.

Results:One hundred and twenty-one and 107 VLBW babies admitted in year before and after guideline, data available in 110 and 102 charts respectively. Thirty-three (33/110) and 31 (31/102) babies were eligible for fluconazole prophylaxis in pre and post prophylaxis periods respectively. Six (6/33) babies eligible for prophylaxis developed culture proven candida sepsis before the guideline compared with no (0/31) babies after (p= 0.03). One baby (1/31) did develop probable candida sepsis in the post prophylaxis period. During both study periods all candida isolates remained fully susceptible to fluconazole.

Conclusions:Selective anti-fungal prophylaxis has reduced invasive fungal sepsis in our unit without evidence of fluconazole resistance emerging. Abstract word count =235

Keywords: VLBW babies, fluconazole, fungal sepsis, prophylaxis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Fantoms

Martin Ward Platt
Arch. Dis. Child. Fetal Neonatal Ed. 2007 92: F423. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Manzoni, P, Mostert, M, Jacqz-Aigrain, E, Farina, D (2009). The use of fluconazole in neonatal intensive care units. Arch. Dis. Child. 94: 983-987 [Abstract] [Full Text]  
• Brecht, M, Clerihew, L, McGuire, W (2009). Prevention and treatment of invasive fungal infection in very low birthweight infants. Arch. Dis. Child. Fetal Neonatal Ed. 94: F65-F69 [Abstract] [Full Text]  
• Healy, C. M. (2008). Fungal Prophylaxis in the Neonatal Intensive Care Unit. NeoReviews 9: e562-e570 [Abstract] [Full Text]