PMID- 16326690
OWN - NLM
STAT- MEDLINE
DCOM- 20060207
LR  - 20131121
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 117
IP  - 1
DP  - 2006 Jan
TI  - Prophylactic fluconazole is effective in preventing fungal colonization and 
      fungal systemic infections in preterm neonates: a single-center, 6-year, 
      retrospective cohort study.
PG  - e22-32
AB  - OBJECTIVE: Despite the promising preliminary results observed in extremely low 
      birth weight (ELBW) populations, the use of fluconazole to prevent fungal 
      colonization and infection in preterm neonates in the NICU is still an open 
      question and not yet recommended as a standard of care. We have reviewed our 
      6-year series to assess the effectiveness and safety of this form of prophylaxis. 
      METHODS: This retrospective study consisted of 465 neonates who weighed < 1500 g 
      at birth and were admitted to our NICU in the period 1998-2003. Those who were 
      born between 1998 and 2000 and did not receive fluconazole prophylaxis (group A, 
      n = 240) were compared with those who were born between 2001 and 2003 and treated 
      with fluconazole until the 30th day of life (45th for neonates < 1000 g at birth; 
      group B, n = 225). Weekly surveillance cultures were obtained from all patients. 
      Incidence of fungal colonization, incidence of systemic fungal infection (SFI), 
      rate of progression from colonization to infection, and mortality rates 
      attributable to fungi were calculated for both groups and separately for neonates 
      who were < 1000 g (ELBW) and were 1001 to 1500 g (NE-VLBW) at birth. RESULTS: 
      Overall fungal colonization was significantly lower in group B (24.0%) than in 
      group A (43.8%; relative risk [RR]: 0.406; 95% confidence interval [CI]: 
      0.273-0.605). The same was true of neonates with colonization in multiple sites 
      (2.6% vs 5.8%) and of those with colonization from high-risk sites (5.8% vs 
      19.2%). SFI incidence was significantly lower in group B (10 of 225 cases; 4.4%) 
      than in group A (40 of 240 cases; 16.7%; RR: 0.233; 95% CI: 0.113-0.447). 
      Reduction of both colonization and SFI in group B was greater in the ELBW 
      neonates and also significant in the NE-VLBW neonates. Rate of progression from 
      colonization to infection was significantly lower in group B (0.17 vs 0.38; RR: 
      0.369; 95% CI: 0.159-0.815). Crude mortality rate attributable to Candida species 
      was 1.7% (4 of 240) in group A vs 0% (0 of 225) in group B. Overall mortality 
      rate (any cause before hospital discharge) was similar in the two groups (11.2% 
      vs 10.6%), but in colonized infants (n = 159), it was significantly lower in 
      group B (3.7% vs 18.1%; RR: 0.174; 95% CI: 0.039-0.778). The incidence of 
      natively fluconazole-resistant fungal species did not increase over the years, 
      and patterns of sensitivity to fluconazole remained the same. No adverse reaction 
      related to fluconazole occurred. CONCLUSIONS: Prophylactic fluconazole 
      significantly reduces the incidence of colonization and systemic infection by 
      Candida species in both ELBW and NE-VLBW neonates and decreases the rates of 
      progression from initial colonization to massive colonization and to systemic 
      infection. All VLBW neonates may benefit from fluconazole prophylaxis.
FAU - Manzoni, Paolo
AU  - Manzoni P
AD  - Neonatology and Hospital NICU, Azienda Ospedaliera Regina Margherita-S. Anna, 
      Turin, Italy. paolomanzoni@hotmail.com
FAU - Arisio, Riccardo
AU  - Arisio R
FAU - Mostert, Michael
AU  - Mostert M
FAU - Leonessa, MariaLisa
AU  - Leonessa M
FAU - Farina, Daniele
AU  - Farina D
FAU - Latino, Maria Agnese
AU  - Latino MA
FAU - Gomirato, Giovanna
AU  - Gomirato G
LA  - eng
PT  - Journal Article
DEP - 20051201
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
RN  - 0 (Antifungal Agents)
RN  - 8VZV102JFY (Fluconazole)
SB  - IM
CIN - Pediatrics. 2006 Jan;117(1):214-5. PMID: 16396881
MH  - Antifungal Agents/adverse effects/*therapeutic use
MH  - Aspergillosis/*prevention & control
MH  - Candida/drug effects
MH  - Candidiasis/*prevention & control
MH  - Fluconazole/adverse effects/*therapeutic use
MH  - Humans
MH  - Infant, Newborn
MH  - Infant, Premature, Diseases/*prevention & control
MH  - Infant, Very Low Birth Weight
MH  - Microbial Sensitivity Tests
EDAT- 2005/12/06 09:00
MHDA- 2006/02/08 09:00
CRDT- 2005/12/06 09:00
PHST- 2005/12/06 09:00 [pubmed]
PHST- 2006/02/08 09:00 [medline]
PHST- 2005/12/06 09:00 [entrez]
AID - peds.2004-2227 [pii]
AID - 10.1542/peds.2004-2227 [doi]
PST - ppublish
SO  - Pediatrics. 2006 Jan;117(1):e22-32. doi: 10.1542/peds.2004-2227. Epub 2005 Dec 1.