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Routine use of fluconazole prophylaxis in a neonatal intensive care unit does not select natively

Paolo Manzoni1, Marialisa Leonessa, Paolo Galletto

  • 1Neonatology and Hospital NICU, Azienda Ospedaliera Regina Margherita-S. Anna C. Spezia 60, 10136 Torino, Italy. paolomanzoni@hotmail.com

The Pediatric Infectious Disease Journal
|July 5, 2008
PubMed

Insights

Routine fluconazole prophylaxis in very low birth weight (VLBW) infants did not increase rates of fluconazole-resistant Candida species. This antifungal strategy remains effective for preventing fungal colonization and infection in this vulnerable population.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Fluconazole prophylaxis is standard for very low birth weight (VLBW) infants to prevent fungal infections.
  • Prolonged use raises concerns about emerging antifungal resistance and fluconazole-resistant Candida species.

Purpose of the Study:

  • To assess the impact of routine fluconazole prophylaxis on the incidence of fluconazole-resistant Candida species in VLBW infants.
  • To compare the prevalence of resistant Candida species before and after the implementation of prophylaxis.

Main Methods:

  • Retrospective analysis of clinical and surveillance fungal isolates from VLBW infants over a 10-year period (1997-2006).
  • Fungal isolates were speciated, and incidence rates of colonization and infection by natively fluconazole-resistant (NFR) Candida species were calculated.
  • Comparison between a 6-year prophylaxis period (2001-2006) and a 4-year preprophylaxis period (1997-2000).

Main Results:

  • Colonization by NFR-Candida species ranged from 2.8% to 6.6% annually, with no increasing trend observed.
  • 18 of 434 (4.1%) VLBW infants were colonized by NFR-Candida species.
  • Five systemic infections (1.1% incidence) by NFR-Candida species occurred, with no significant difference compared to the preprophylaxis period (3.7% colonization, 1.4% infection).

Conclusions:

  • Routine fluconazole prophylaxis in VLBW neonates does not lead to the emergence of natively fluconazole-resistant Candida species.
  • The antifungal prophylaxis strategy remains effective in preventing resistant fungal infections in this population.
Abstract

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