European Journal of Pediatrics

, Volume 171, Issue 10, pp 1481–1487

Targeted fluconazole prophylaxis for high-risk very low birth weight infants

  • Asaph Rolnitsky
  • Itzhak Levy
  • Lea Sirota
  • Itamar Shalit
  • Gil Klinger
Original Paper

DOI: 10.1007/s00431-012-1760-2

Cite this article as:
Rolnitsky, A., Levy, I., Sirota, L. et al. Eur J Pediatr (2012) 171: 1481. doi:10.1007/s00431-012-1760-2

Abstract

Antifungal prophylaxis is increasingly used in very low birth weight (VLBW) infants who are at risk for severe fungal infections. Our objective was to assess the effectiveness of targeted fluconazole prophylaxis for high-risk VLBW infants. A retrospective cohort study with historical controls was performed. During the period 2007–2008, all high-risk VLBW infants (birth weight, ≤1,000 g; gestational age, ≤28 weeks; seven antimicrobial therapy or additional risk factors present) received fluconazole prophylaxis until risk factors were not present. Treated infants were compared to a gestational age- and birth weight-matched untreated cohort. Statistical analyses used univariate and multivariate analyses. The main outcome variable was a breakthrough fungal bloodstream infection (BSI). The prophylaxis cohort of 130 VLBW infants was compared to 319 control infants. The rate of fungal infections was significantly lower in the fluconazole prophylaxis group (1 of 130 vs. 19 of 319, p = 0.016); however, they did not differ in mortality (16.2 vs. 15 %, p = 0.77) or complications of prematurity. Fluconazole prophylaxis was associated with a significant decrease in candidal BSI (odds ratio, 0.05; 95 % confidence interval, 0.005–0.523). Selective vs. nonselective prophylaxis reduced the number of infants treated from 247 to 130. Conclusion Targeted fluconazole prophylaxis in VLBW infants is effective in preventing fungal infections without increasing the risk of BSI among low-risk infants.

Keywords

Very low birth weight infantFluconazoleSelective antifungal prophylaxisCandida

Abbreviations

VLBW

Very low birth weight

NICU

Neonatal intensive care unit

BSI

Bloodstream infection

OR

Odds ratio

CI

Confidence interval

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Asaph Rolnitsky
    • 1
    • 3
  • Itzhak Levy
    • 2
    • 3
  • Lea Sirota
    • 1
    • 3
  • Itamar Shalit
    • 2
    • 3
  • Gil Klinger
    • 1
    • 3
  1. 1.Neonatal Intensive Care UnitSchneider Children’s Medical Center of IsraelPetah TikvaIsrael
  2. 2.Infectious Disease UnitSchneider Children’s Medical Center of IsraelPetah TikvaIsrael
  3. 3.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael