Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
Pediatr Infect Dis J. 2010 Apr;29(4):352-6. doi: 10.1097/INF.0b013e3181bf8eb1.
Invasive fungal infections (IFI) are an important cause of late-onset disease in extremely low birth weight (ELBW) infants. Despite prior trials of fluconazole prophylaxis in neonates, application of this regimen remains controversial. Review of our neonatal intensive care unit aggregate annual number of fungal isolates from sterile sites in ELBW infants from 1997 to 2006 suggested a significant decrease following the institution of routine prophylactic fluconazole in February 2002. We undertook a retrospective study to document the efficacy and adverse effects of routine fluconazole prophylaxis.
ELBW infants admitted during 2000 to 2006 were divided into 2 groups: Control group-admitted before the institution of fluconazole prophylaxis, and Fluconazole group-admitted after institution of fluconazole prophylaxis. Primary outcome was the frequency of IFI. Secondary outcome was the frequency of cholestasis, which has been rarely reported with fluconazole use.
Data were extracted from 262 infant records: control 99, fluconazole 163. Baseline demographics and potentially confounding variables differed between the 2 groups with greater birth weight, greater gestational age, shorter durations of ventilation and central catheter use, and earlier start of feeding in the control group, reflecting healthier control infants. Frequency of IFI was 7.1% in the control group versus 1.8% in the fluconazole group, P = 0.045. Logistic regression revealed that fluconazole prophylaxis was independently associated with a lower risk of IFI. There was no difference in the frequency of cholestasis between the control and fluconazole groups.
Prophylactic administration of fluconazole to all ELBW infants was associated with significantly decreased rates of IFI without associated adverse effects.
侵袭性真菌感染（IFI）是极低出生体重（ELBW）婴儿晚期发病的一个重要原因。尽管先前有研究表明氟康唑预防治疗可用于新生儿，但该方案的应用仍存在争议。对我们新生儿重症监护病房（NICU）从 1997 年至 2006 年无菌部位真菌分离株的年度总数进行回顾性分析表明，2002 年 2 月常规应用氟康唑预防后，真菌感染的数量显著减少。我们进行了一项回顾性研究，以记录常规氟康唑预防的疗效和不良反应。
将 2000 年至 2006 年期间入住的 ELBW 婴儿分为两组：对照组，在氟康唑预防之前入院；氟康唑组，在氟康唑预防之后入院。主要结局是 IFI 的发生频率。次要结局是胆汁淤积的发生频率，氟康唑使用中很少有报道这种不良反应。
从 262 例婴儿的记录中提取数据：对照组 99 例，氟康唑组 163 例。两组的基线人口统计学和潜在混杂变量存在差异，对照组的出生体重较大、胎龄较大、通气和中心置管时间较短、喂养开始较早，表明对照组婴儿的情况更为健康。对照组 IFI 的发生率为 7.1%，氟康唑组为 1.8%，P=0.045。Logistic 回归分析显示，氟康唑预防与 IFI 的风险降低独立相关。对照组和氟康唑组的胆汁淤积发生率无差异。
对所有 ELBW 婴儿常规应用氟康唑可显著降低 IFI 的发生率，且无不良反应。
