SAN DIEGO, CA— David A. Kaufman, MD, from the University of Virginia, Charlottesville, presented study findings at IDWeek 2012 that showed targeted prophylaxis of fluconazole in infants <1,000g or ≤27 weeks using a 3mg/kg twice-weekly dose with a different antifungal used for treatment is effective in preventing invasive Candida infections.
Dr. Kaufman and colleagues conducted a prospective study of fluconazole susceptibilities of fungal surveillance and clinical isolates in patients receiving fluconazole prophylaxis and the incidence of invasive Candida infections and Candida-related mortality. Infants <1,000g or ≤27 weeks, as well as any NICU patients with necrotizing enterocolitis or gastroschisis, received fluconazole prophylaxis until intravenous access (central or peripheral) was no longer required.
Amphotericin was used for treatment (empiric, presumed, or proven infections). Surveillance colonization cultures were prospectively collected during fungal prophylaxis. All surveillance and clinical isolates had antifungal susceptibilities performed using microbroth dilution or disk diffusion.
Data on 715 infants weighing <1,000g or ≤27 weeks who received fluconazole prophylaxis were collected from 1998–2011. Baseline colonization was 7.7%. Mean length of fluconazole prophylaxis was 4.2±1.6 weeks. At the end of fluconazole prophylaxis, 5% of infants were colonized. No Candida albicans resistance was observed and colonization with non-albicans resistant isolates occurred in <1% of patients. Over the 13-year period, 9 of 715 (1.25%) of high-risk preterm infants<1,000g or ≤27 weeks developed an ICI (all were Candida blood stream infections) while receiving fluconazole prophylaxis. All infected infants were successfully treated with amphotericin and catheter removal. There was no Candida-related mortality.
In 2005, fluconazole prophylaxis was broadened to infants >1,000g with complex gastrointestinal disease. Since then, 31 patients with necrotizing enterocolitis and 46 patients with gastroschisis received fluconazole prophylaxis. None of these complex gastrointestinal disease infants developed an invasive Candida infection. This is in comparison to 13% of infants (6 of 45) with complicated gastrointestinal disease who developed an invasive Candida infection between 2000–2004. None of the other infants admitted to the NICU between 2004–2011 with birthweights 1,000–1,499g (n=384) or >1,500g (n=3,124) developed invasive Candida infections.
Dr. Kaufman noted, “targeted fluconazole prophylaxis given to any NICU patient with necrotizing enterocolitis or gastroschisis has eliminated invasive Candida infections in complicated gastrointestinal diseases and for all infants >1,000g.”