Prophylactic fluconazole protocol in very low birth weight infants: invasive candidiasis prevention in a Latin American neonatal intensive care unit.
Journal
Journal of perinatology : official journal of the California Perinatal Association
ISSN: 1476-5543
Titre abrégé: J Perinatol
Pays: United States
ID NLM: 8501884
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
06
05
2022
accepted:
12
05
2023
revised:
29
03
2023
medline:
14
9
2023
pubmed:
31
5
2023
entrez:
30
5
2023
Statut:
ppublish
Résumé
To evaluate the effect of prophylactic fluconazole for very low birth weight infants (VLBWI) in a neonatal intensive care unit (NICU) with a 7.8% incidence of invasive candidiasis (IC). Interventional pre-post cohort study comparing 2 years with and without fluconazole prophylaxis protocol (2016-2018 = 228 infants and 2019-2021 = 125 infants). Fluconazole was administered to all extremely low birth weight infants (ELBWI) and infants with BW 1001-1500 g with risk factors or positive carrier cultures. Liver function tests were performed weekly. The incidence of IC decreased from 7.8% to 2.4% (OR:0.3, p = 0.05) with the use of prophylactic fluconazole for VLBWI and in ELBWI decreased from 16,7% to 3,7% (OR:0.1, p = 0.04). No significant differences were seen in mortality. Fluconazole is a safe, effective, and feasible strategy to prevent IC in a Latin American country.
Identifiants
pubmed: 37253780
doi: 10.1038/s41372-023-01699-0
pii: 10.1038/s41372-023-01699-0
doi:
Substances chimiques
Fluconazole
8VZV102JFY
Antifungal Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1139-1144Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.
Références
Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, et al. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007;356:2483–95.
doi: 10.1056/NEJMoa065733
pubmed: 17568029
Izquierdo G, Santolaya ME. [Invasive candidiasis in newborns: diagnosis, treatment, and prophylaxis]. Rev Chilena Infectol. 2014;31:73–83.
doi: 10.4067/S0716-10182014000100011
pubmed: 24740778
Cleminson J, Austin N, McGuire W. Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants. Cochrane Database Syst Rev. 2015;2015:CD003850.
pubmed: 26497056
pmcid: 7156892
Manzoni P, Arisio R, Mostert M, Leonessa ML, Farina D, Latino MA, et al. Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics. 2006;117:e22–32.
doi: 10.1542/peds.2004-2227
pubmed: 16326690
Santolaya ME, Thompson L, Benadof D, Tapia C, Legarraga P, Cortés C, et al. A prospective, multi-center study of Candida bloodstream infections in Chile. PLoS One. 2019;14:e0212924.
doi: 10.1371/journal.pone.0212924
pubmed: 30849092
pmcid: 6407853
Benjamin DK Jr, Hudak ML, Duara S, Randolph DA, Bidegain M, Mundakel GT, et al. Effect of fluconazole prophylaxis on candidiasis and mortality in premature infants: a randomized clinical trial. JAMA. 2014;311:1742–9.
doi: 10.1001/jama.2014.2624
pubmed: 24794367
pmcid: 4110724
Bertini G, Perugi S, Dani C, Filippi L, Pratesi S, Rubaltelli FF. Fluconazole prophylaxis prevents invasive fungal infection in high-risk, very low birth weight infants. J Pediatr. 2005;147:162–5.
doi: 10.1016/j.jpeds.2005.02.020
pubmed: 16126042
Rios JFDS, Camargos PAM, Correa LP, Romanelli RMC. Fluconazole prophylaxis in preterm infants: a systematic review. Braz J Infect Dis. 2017;21:333–8.
doi: 10.1016/j.bjid.2017.01.008
pubmed: 28286016
pmcid: 9428001
Santolaya ME, Alvarado Matute T, de Queiroz Telles F, Colombo AL, Zutita J, Tiraboschi IN, et al. Recommendations for the management of candidemia in neonates in Latin America. Latin America Invasive Mycosis Network. Rev Iberoam Micol. 2013;30:158–70.
pubmed: 23764559
Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med. 2001;345:1660–6.
doi: 10.1056/NEJMoa010494
pubmed: 11759644
Polin RA, Denson S, Brady MT, Committee on Fetus and Newborn; Committee on Infectious Diseases. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics. 2012;129:e1104–9.
doi: 10.1542/peds.2012-0147
pubmed: 22451708
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O´Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.
doi: 10.1086/599376
pubmed: 19489710
Lai A, Rove KO, Amin S, Vricella GJ, Coplen DE. Diagnosis and Management of Urinary Tract Infections in Premature and Term Infants. NeoReviews. 2018;19:e337–e348.
doi: 10.1542/neo.19-6-e337
Claassen CC, Keenan WJ. Challenging the “Culture” of the Tracheal Aspirate. Neoreviews. 2019;20:e145–e151.
doi: 10.1542/neo.20-3-e145
pubmed: 31261052
Tunkel AR, Hartman BJ, Kaplan SL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–84.
doi: 10.1086/425368
pubmed: 15494903
Melkie M, Yigeremu M, Nigussie P, Asrat S, Gebreegziabher T, Teka T, et al. Robust reference intervals for liver function test (LFT) analytes in newborns and infants. BMC Res Notes. 2012;5:493.
doi: 10.1186/1756-0500-5-493
pubmed: 22958834
pmcid: 3564864
Ericson JE, Kaufman DA, Kicklighter SD, Bhatia J, Testoni D, Gao J, et al. Fluconazole Prophylaxis for the Prevention of Candidiasis in Premature Infants: A Meta-analysis Using Patient-level Data. Clin Infect Dis. 2016;63:604–10.
doi: 10.1093/cid/ciw363
pubmed: 27298330
pmcid: 4981761
Lee J, Kim HS, Shin SH, Choi CW, Kim EK, Choi EH, et al. Efficacy and safety of fluconazole prophylaxis in extremely low birth weight infants: multicenter pre-post cohort study. BMC Pediatr. 2016;16:67.
doi: 10.1186/s12887-016-0605-y
pubmed: 27184665
pmcid: 4869366
Luparia M, Landi F, Mesini A, Militello MA, Galletto P, Farina D, et al. Fungal Ecology in a Tertiary Neonatal Intensive Care Unit after 16 Years of Routine Fluconazole Prophylaxis: No Emergence of Native Fluconazole-Resistant Strains. Am J Perinatol. 2019;36:S126–S133.
doi: 10.1055/s-0039-1691808
pubmed: 31238373