Effect of Fluconazole Prophylaxis to Control Candida Infection in High-Risk Preterm Infants

Kim, Chun Soo; Hong, Seung Ah; Lee, Sang Lak; Kim, Heung Sik

Abstract

OBJECTIVE
Candida species are becoming one of the most common pathogens associated with nosocomial infection in the neonatal intensive care units (NICU). This study was undertaken to evaluate the efficacy of fluconazole prophylaxis (FP) to control candida infection in high-risk preterm infants.
METHODS
A prospective, randomized clinical trial was conducted over a 17-month period (Aug. 2008-Dec. 2009) in very low birth weight (VLBW) infants who were admitted to NICU of Dongsan Medical Center, Keimyung University. The 55 VLBW infants with mechanical ventilation, central vascular access and parenteral nutrition at early time of life were enrolled for this study. The infants were randomly assigned to FP and control group in the first three days of life. Fluconazole was administered by intravenous route for 4- to 6-week after birth at dose of 3 mg per kilogram of body weight. All enrolled infants underwent weekly surveillance culture for candida colonization.
RESULTS
The 28 infants with FP and the 27 control infants were similar in comparison of the perinatal parameters such as gestational age, birth weight and antenatal steroid therapy. And also, there were no differences between the two groups in terms of presence of common risk factors for invasive candida infection. During prophylactic period, candida colonization was identified in 5 infants of the fluconazole group and 15 infants of the control group (17.9% vs. 55.6%; P<0.005). And also candida sepsis was more frequently developed in the control group, but the result was not significant. No differences in liver function tests after prophylactic period were noted. Between two groups, prognostic factors such as duration of stay in hospital, combined diseases and mortality were not different.
CONCLUSIONS
FP may help to control candida infection in high-risk preterm infants, but large scaled multicenter studies including development of resistant strains are necessary before initiation of routine prophylaxis.