Efficacy of Fluconazole Prophylaxis on Invasive Candidiasis Infection in Extremely Low Birth Weight Neonates

Background: Invasive candidiasis infection is one of the main life-threatening problems for extremely low birth weight (ELBW) neonates who are in the neonatal intensive care unit (NICU). Candidiasis can cause mortality, short-term morbidity, and long-term neurodevelopmental outcome in infected infants who survive. Therefore, since several years ago fluconazole prophylaxis has begun for premature newborns who were admitted to NICUs in some parts of the world.Methods: In this retrospective cohort, the population study was all the infants of less than 1,000 gram admitted to Valiasr Hospital during the years 2011-2016. The subjects were divided into two groups of control and intervention. The control group did not receive any fluconazole prophylaxis, while for the test group, intravenous fluconazole was administered. Finally, we compared the incidence of candidiasis between the two groups.Results: Fluconazole was administered to 70 out of 167 neonates. Our findings showed that two infants of the prophylaxis group (2.9%) and two (1.2%) of the non-prophylaxis group were infected with Candida species. The difference between the two groups was not statistically significant (P=0.501). Among the risk factors, bacterial sepsis, the duration of central catheter installation, total parenteral nutrition, meropenem or vancomycin administration, and hospitalization costs were significantly related to the incidence of invasive candidiasis infection.Conclusion: The incidence of candidiasis in our study was 2.39% and fluconazole prophylaxis has not been effective in reducing fungal infections. Consequently, further investigations in larger sample sizes with different study settings and a variety of methodologies are needed to evaluate the efficacy of fluconazole prophylaxis on invasive candidiasis infection in ELBW neonates.