902. Evaluation of Invasive Fungal Infections in Preterm Neonates with and without Fluconazole Prophylaxis
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  With increasing survival of preterm neonates, systemic fungal infections (SFI) are a growing concern.  Several studies have described the successful use of prophylactic fluconazole in the prevention of SFIs. However, data remains controversial and fungal prophylaxis is not routinely used in all hospitals as the standard of care.  We evaluated the efficacy of fluconazole prophylaxis in preventing invasive infection at two University hospitals and compared this to a community hospital that did not use prophylaxis.

Methods:  After Insitutional Review board (IRB) approval this retrospective study evaluated neonates weighing < 1000g at birth admitted to NICUs at three institutions between Jan 2004 and April 2010.  We compared SFI among those who were born between Jan 2004 and May 2008 and did not receive fungal prophylaxis to those born between June 2008 and April 2010 after the prophylaxis was instated at both Universities.  This was then compared to a community hospital which did not use fungal prophylaxis.  We also evaluated the mortality, and other risk factors for SFI (co-existing bacterial infection, systemic steroids, multiple gestation, sex, gestation age, preeclampsia).We applied Chi-square and Fisher’s exact test for analysis.

Results:  Among 382 neonates, SFI incidence was 63 (16.5%).  Incidence was significantly lower in prophylaxis groups (Universities 0 of 32; and 1 of 34; 2.9%) compared to those without (20 of 92; 21.7%; 20 of 95; 21.1%;p≤ 0.0002; 15 of 83; 18.1%).  There was not a significant mortality difference between those with and without a SFI (24.2% vs 16.9%; p =0.18).  Incidence of SFI significantly increased with coexisting bacterial infection (25.8% vs. 11.2%; p ≤0.0012), systemic steroids (30.5% vs. 7.5%; p≤0.0001), multiple gestation (34.5% vs.16.3%; p≤0.0016) and male sex (24.7% vs. 13.7%; p≤0.014), lower mean gestational age (24.8 weeks vs 26.2 weeks;p≤0.0001).  Associated maternal preeclampsia/PIH had a lower incidence of SFI (6.4% vs 24.2%; p ≤0.0018). 

Conclusion:  The risk factors for SFI are multifactorial and prophylactic fluconazole significantly reduces the incidence of SFI in extremely low birth weight neonates without reducing the mortality.



Subject Category: M. Mycology including clinical and basic studies of fungal infections

Erin Senozan1, Murphy Steiner1, Xiang Fang, PhD1, John Schmidt, MD, MPH1, Brady Kerr, MD2 and Meera Varman, MD1, (1)Creighton University School of Medicine, Omaha, NE, (2)Methodist Women's Hospital, Omaha, NE

Disclosures:

E. Senozan, None

M. Steiner, None

X. Fang, None

J. Schmidt, None

B. Kerr, None

M. Varman, None

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