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Strategies for the prevention of neonatal candidiasis

Eugene Leibovitz1

  • 1Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. eugenel@bgu.ac.il

Pediatrics and Neonatology
|April 17, 2012
PubMed

Insights

Prophylactic fluconazole significantly reduced fungal colonization and sepsis in very-low-birth-weight infants (VLBWI). This safe intervention shows promise in preventing invasive fungal infections and mortality in high-risk neonates.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections are a major cause of mortality in very-low-birth-weight infants (VLBWI).
  • Risk factors for fungal sepsis include increased colonization due to maternal transmission or nosocomial acquisition.
  • Fungal colonization correlates with the progression to invasive candidemia.

Purpose of the Study:

  • To evaluate the efficacy and safety of intravenous fluconazole prophylaxis in preventing invasive fungal infections in at-risk preterm infants.
  • To assess the impact of fluconazole on fungal colonization and Candida-related mortality.

Main Methods:

  • Randomized, single and multiple-center, placebo-controlled trials were conducted.
  • Intravenous fluconazole prophylaxis was administered to preterm infants weighing <1500 g.
  • Safety and development of fungal resistance were monitored.

Main Results:

  • Intravenous fluconazole prophylaxis effectively decreased fungal colonization and sepsis in at-risk preterm infants.
  • The prophylactic use of fluconazole was found to be safe.
  • No significant development of fungal resistance was observed.

Conclusions:

  • Fluconazole prophylaxis is effective and safe for preventing invasive fungal infections in very-low-birth-weight infants.
  • Administering fluconazole to preterm neonates (<1000 g birth weight or ≤27 weeks' gestation) can reduce or eliminate invasive fungal infections and related mortality.

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