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