Effects of Fluconazole Prophylaxis against Systemic Fungal Infection in Extremely-low-birth-weight Infants

Background: Prophylactic administration of fluconazole has been demonstrated to be effective in reducing systemic fungal infection in extremely-low-birth-weight (ELBW) infants. This study investigated the effects and side effects of this regimen in a tertiary care center Methods: ELBW infants younger than 5 days old admited to the Neonatal Intensive Care Unit of a university hospital between May 2000 and April 2004 were enrolled. Period A, May 2000 to April 2002, was used as the baseline. Period B, May 2002 to April 2004, was the period of fluconazole prophylaxis. Fluconazole (3 mg/kg) was administered intravenously every 72 h in the first 2 wks of life, every 48 h at 3-4 wks, and every 24 h at 5-6 wks. Laboratory parameters were recorded weekly for 7 weeks. Patient data, including predisposing factors, incidence of systemic infections, and blood chemistry tests in ELBW infants were compared between Period A and B. Results: There were 49 ELBW infants in period A and 57 infants in period B. The mean gestational age, birth weight, antenatal interventions, and delivery modes of the infants were similar in both groups. There were no significant differences in the distribution of risk factors between periods. However nine patients (18.4%) developed fungemia during period A, and 4 patients (7.0%) during period B. Only two (3.5%) contracted fungemia during chemoprophylaxis. The incidence of fungemia was lower in period B (0.65 per 1000 patient-days) than in period A (3.54 per 1000 patient-days). (95% C.I. -5.37 to -0.41 per 1000 patient-days, p=0.01). The age at onset of fungemia (36.3±8.7 days) in period B was significantly older than in period A (20.6±4.1 days, p=0.04). There was no fungemia-related mortality in period B. In contrast, 5 patients (55%) with fungemia died, and 2 (22%) had fungus-related mortality in period A. Conclusions: Early prophylaxis with fluconazole in ELBW infants decreased the incidence of fungemia without increasing adverse events. Whether a prolonged duration of medication would provide better coverage requires further study.

並列關鍵字

Fluconazole ； chemoprophylaxis ； extremely-low-birth-weight ； fungemia

國際替代計量

全文下載

主題瀏覽