Fluconazole Prophylaxis against Fungal Colonization and Infection in Preterm Infants

Invasive fungal infections cause substantial morbidity and mortality in preterm infants. In this single-center, double-blind, placebo-controlled trial, extremely-low-birth-weight preterm infants who were given the antifungal agent fluconazole prophylactically for six weeks had significantly lower ra...

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Published in:The New England journal of medicine Vol. 345; no. 23; pp. 1660 - 1666
Main Authors: Kaufman, David, Boyle, Robert, Hazen, Kevin C, Patrie, James T, Robinson, Melinda, Donowitz, Leigh Goodman
Format: Journal Article
Language:English
Published: Boston, MA Massachusetts Medical Society 06-12-2001
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Abstract Invasive fungal infections cause substantial morbidity and mortality in preterm infants. In this single-center, double-blind, placebo-controlled trial, extremely-low-birth-weight preterm infants who were given the antifungal agent fluconazole prophylactically for six weeks had significantly lower rates of fungal colonization and systemic fungal infection than control infants, without development of resistance to fluconazole or adverse effects on liver enzymes. The use of fluconazole reduced the incidence of invasive fungal infection in extremely-low-birth-weight infants. Despite aggressive antifungal treatment of invasive candida infection, systemic fungal disease is increasing in prevalence and leads to high rates of illness and death among preterm infants. 1 , 2 Candida species rapidly colonize the skin and mucous membranes of about 60 percent of critically ill neonates and can progress to invasive infection. 2 , 3 Fungal infection accounts for 9 percent of cases of late-onset sepsis in infants who weigh less than 1500 g and is associated with a mortality rate of 28 percent, as compared with 7 percent among infants in whom no infection develops. 1 Critically ill neonates are at an increased . . .
AbstractList Invasive fungal infections cause substantial morbidity and mortality in preterm infants. In this single-center, double-blind, placebo-controlled trial, extremely-low-birth-weight preterm infants who were given the antifungal agent fluconazole prophylactically for six weeks had significantly lower rates of fungal colonization and systemic fungal infection than control infants, without development of resistance to fluconazole or adverse effects on liver enzymes. The use of fluconazole reduced the incidence of invasive fungal infection in extremely-low-birth-weight infants. Despite aggressive antifungal treatment of invasive candida infection, systemic fungal disease is increasing in prevalence and leads to high rates of illness and death among preterm infants. 1 , 2 Candida species rapidly colonize the skin and mucous membranes of about 60 percent of critically ill neonates and can progress to invasive infection. 2 , 3 Fungal infection accounts for 9 percent of cases of late-onset sepsis in infants who weigh less than 1500 g and is associated with a mortality rate of 28 percent, as compared with 7 percent among infants in whom no infection develops. 1 Critically ill neonates are at an increased . . .
Background Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. We evaluated the efficacy of prophylactic fluconazole in preventing fungal colonization and invasive infection in extremely-low-birth-weight infants. Methods We conducted a prospective, randomized, double-blind clinical trial over a 30-month period in 100 preterm infants with birth weights of less than 1000 g. The infants were randomly assigned during the first five days of life to receive either intravenous fluconazole or placebo for six weeks. We obtained weekly surveillance cultures from all patients. Results The 50 infants randomly assigned to fluconazole and the 50 control infants were similar in terms of birth weight, gestational age at birth, and base-line risk factors for fungal infection. During the six-week treatment period, fungal colonization was documented in 30 infants in the placebo group (60 percent) and 11 infants in the fluconazole group (22 percent; difference in risk, 0.38; 95 percent confidence interval, 0.18 to 0.56; P=0.002). Invasive fungal infection with positive growth of fungal isolates from the blood, urine, or cerebrospinal fluid developed in 10 infants in the placebo group (20 percent) and none of the infants in the fluconazole group (difference in risk, 0.20; 95 percent confidence interval, 0.04 to 0.36; P=0.008). The sensitivities of the fungal isolates to fluconazole did not change during the study, and no adverse effects of the fluconazole therapy were documented. Conclusions Prophylactic administration of fluconazole during the first six weeks of life is effective in preventing fungal colonization and invasive fungal infection in infants with birth weights of less than 1000 g.
Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. We evaluated the efficacy of prophylactic fluconazole in preventing fungal colonization and invasive infection in extremely-low-birth-weight infants. We conducted a prospective, randomized, double-blind clinical trial over a 30-month period in 100 preterm infants with birth weights of less than 1000 g. The infants were randomly assigned during the first five days of life to receive either intravenous fluconazole or placebo for six weeks. We obtained weekly surveillance cultures from all patients. The 50 infants randomly assigned to fluconazole and the 50 control infants were similar in terms of birth weight, gestational age at birth, and base-line risk factors for fungal infection. During the six-week treatment period, fungal colonization was documented in 30 infants in the placebo group (60 percent) and 11 infants in the fluconazole group (22 percent; difference in risk, 0.38; 95 percent confidence interval, 0.18 to 0.56; P=0.002). Invasive fungal infection with positive growth of fungal isolates from the blood, urine, or cerebrospinal fluid developed in 10 infants in the placebo group (20 percent) and none of the infants in the fluconazole group (difference in risk, 0.20; 95 percent confidence interval, 0.04 to 0.36; P=0.008). The sensitivities of the fungal isolates to fluconazole did not change during the study, and no adverse effects of the fluconazole therapy were documented. Prophylactic administration of fluconazole during the first six weeks of life is effective in preventing fungal colonization and invasive fungal infection in infants with birth weights of less than 1000 g.
Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. We evaluated the efficacy of prophylactic fluconazole in preventing fungal colonization and invasive infection in extremely-low-birth-weight infants. We conducted a prospective, randomized, double-blind clinical trial over a 30-month period in 100 preterm infants with birth weights of less than 1000 g. The infants were randomly assigned during the first five days of life to receive either intravenous fluconazole or placebo for six weeks. We obtained weekly surveillance cultures from all patients. The 50 infants randomly assigned to fluconazole and the 50 control infants were similar in terms of birth weight, gestational age at birth, and base-line risk factors for fungal infection. During the six-week treatment period, fungal colonization was documented in 30 infants in the placebo group (60 percent) and 11 infants in the fluconazole group (22 percent; difference in risk, 0.38; 95 percent confidence interval, 0.18 to 0.56; P=0.002). Invasive fungal infection with positive growth of fungal isolates from the blood, urine, or cerebrospinal fluid developed in 10 infants in the placebo group (20 percent) and none of the infants in the fluconazole group (difference in risk, 0.20; 95 percent confidence interval, 0.04 to 0.36; P=0.008). The sensitivities of the fungal isolates to fluconazole did not change during the study, and no adverse effects of the fluconazole therapy were documented. Prophylactic administration of fluconazole during the first six weeks of life is effective in preventing fungal colonization and invasive fungal infection in infants with birth weights of less than 1000 g.
Author Kaufman, David
Hazen, Kevin C
Robinson, Melinda
Donowitz, Leigh Goodman
Boyle, Robert
Patrie, James T
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  givenname: David
  surname: Kaufman
  fullname: Kaufman, David
– sequence: 2
  givenname: Robert
  surname: Boyle
  fullname: Boyle, Robert
– sequence: 3
  givenname: Kevin C
  surname: Hazen
  fullname: Hazen, Kevin C
– sequence: 4
  givenname: James T
  surname: Patrie
  fullname: Patrie, James T
– sequence: 5
  givenname: Melinda
  surname: Robinson
  fullname: Robinson, Melinda
– sequence: 6
  givenname: Leigh Goodman
  surname: Donowitz
  fullname: Donowitz, Leigh Goodman
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Issue 23
Keywords Human
Infection
Premature
Prevention
Antifungal agent
Chemotherapy
Newborn
Fluconazole
Mycosis
Triazole derivatives
Extremely low birthweight
Colonization
Language English
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Snippet Invasive fungal infections cause substantial morbidity and mortality in preterm infants. In this single-center, double-blind, placebo-controlled trial,...
Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. We evaluated the efficacy of prophylactic fluconazole in...
Background Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. We evaluated the efficacy of prophylactic...
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SubjectTerms Antibiotics. Antiinfectious agents. Antiparasitic agents
Antifungal agents
Antifungal Agents - adverse effects
Antifungal Agents - therapeutic use
Babies
Bacterial infections
Bacterial Infections - epidemiology
Biological and medical sciences
Birth weight
Candida - drug effects
Candida - isolation & purification
Candida albicans - drug effects
Candida albicans - isolation & purification
Candidiasis - prevention & control
Colony Count, Microbial
Double-Blind Method
Fluconazole - adverse effects
Fluconazole - therapeutic use
Fungal infections
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - prevention & control
Infant, Very Low Birth Weight
Infusions, Intravenous
Intensive care
Medical sciences
Microbial Sensitivity Tests
Mortality
Mycoses - prevention & control
Pharmacology. Drug treatments
Prospective Studies
Trichosporon - isolation & purification
Title Fluconazole Prophylaxis against Fungal Colonization and Infection in Preterm Infants
URI http://dx.doi.org/10.1056/NEJMoa010494
https://www.ncbi.nlm.nih.gov/pubmed/11759644
https://www.proquest.com/docview/223938711
https://search.proquest.com/docview/18219461
Volume 345
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