Article Text

PDF
Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection
  1. Brian A McCrossan1,
  2. Elaine McHenry2,
  3. Fiona O’Neill3,
  4. Grace Ong2,
  5. David G Sweet1
  1. 1
    Regional Neonatal Intensive Care Unit, Royal Maternity Hospital, Belfast, Northern Ireland, UK
  2. 2
    Department of Microbiology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
  3. 3
    Department of Pharmacy, Royal Victoria Hospital, Belfast, Northern Ireland, UK
  1. 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

Abstract

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.

Statistics from Altmetric.com

Footnotes

  • Competing interests: The authors are not aware of any competing interests.

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

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Fantoms
    Martin Ward Platt