Mortality and risk factors for invasive fungal infections after the implementation of a fluconazole prophylaxis protocol in very low birth weight infants.

Unlabelled: Fungal infections are a common cause of late-onset sepsis in very low birth weight infants and can impact mortality and morbidity. The purpose of this study is to determine the impact of systemic fluconazole prophylaxis in the prevalence of fungemia.

Methods: Subjects included 402 very low birth weight premature infants with birth weights between 500 and 1,250 grams admitted to the University Pediatric Hospital NICU over a six year period. The period before and after prophylaxis was retrospectively compared

Results: There was a marginal decrease in fungemia in the prophylaxis group (2.6% vs. 6.7%, p = 0.0525). Factors associated to fungemia were chorioamnionitis (p = 0.0240), H2-receptor inhibitors use (p = 0.0109), mechanical ventilati (p = 0.0049), prolonged antibiotic t py (p = 0.0015), and parenteral nutriti (p = 0.0048). Infants with fungemia had longer lengths of stay (p = 0.0143) and lower survival (p = 0.002).

Conclusion: Prophylaxis with fluconazole decreases mortality and morbidity in an environment with a high incidence of late onset fungal infections. Early identification and prevention of risk factors must be reinforced.