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Arch Dis Child Fetal Neonatal Ed 2007;92:F454-F458 doi:10.1136/adc.2006.094359
  • Original article
    • Original article

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
  • Accepted 9 April 2007
  • Published Online First 25 April 2007

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.

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

Responses to this article

  • Practical approach to improve prophylaxis against fungal infections
    • Yoram A Bental,
    • Imad R. Makhoul- Meyer Children's Hospital and The Bruce Rappaport Faculty of Medicine-Technion, Israel.
    Arch Dis Child - Fetal Neonatal Ed published online January 9, 2008
  • Prophylaxis to reduce fungal infection in neonates
    • Renato S Procianoy,
    • Rita.C. Silveira
    Arch Dis Child - Fetal Neonatal Ed published online December 14, 2007

This Article

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  4. All versions of this article:
    1. adc.2006.094359v1
    2. 92/6/F454 most recent

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