ArticleJournal of perinatology : official journal of the California Perinatal Association2008
Fluconazole prophylaxis for prevention of invasive fungal infections in targeted highest risk preterm infants limits drug exposure.
Article in Journal of perinatology : official journal of the California Perinatal Association, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
18 citing papers in PubMed, 4 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants.The Cochrane database of systematic reviews · 2015Pooled it
- Safety of fluconazole in paediatrics: a systematic review.European journal of clinical pharmacology · 2013Pooled it
- Fluconazole prophylaxis in preterm infants: a systematic review.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious DiseasesPooled it
- Use of a computerized C-reactive protein (CRP) based sepsis evaluation in very low birth weight (VLBW) infants: a five-year experience.PloS one · 2013Trial
- Irrational and Inappropriate Use of Antifungals in the NICU: A Narrative Review.Antibiotics (Basel, Switzerland) · 2026Review
- Updates in the Pharmacologic Prophylaxis and Treatment of Invasive Candidiasis in the Pediatric and Neonatal Intensive Care Units: Updates in the Pharmacologic Prophylaxis.Current treatment options in infectious diseases · 2022Article
- Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis.Clinical and experimental pediatrics · 2021Article
- Advances in the treatment of invasive neonatal candidiasis.Expert opinion on pharmacotherapy · 2015Review
- Fluconazole prophylaxis is associated with a decreased rate of coagulase-negative Staphylococcal infections in a subset of extremely low birth weight neonates.Medical microbiology and immunology · 2014Article
- Triazole use in the nursery: fluconazole, voriconazole, posaconazole, and ravuconazole.Current drug metabolism · 2013Review
- Treatment and prophylaxis of invasive candidiasis.Seminars in perinatology · 2012Review
- Targeted fluconazole prophylaxis for high-risk very low birth weight infants.European journal of pediatrics · 2012Article
- European survey on the use of prophylactic fluconazole in neonatal intensive care units.European journal of pediatrics · 2012Article
- The use of antifungal therapy in neonatal intensive care.Clinics in perinatology · 2012Review
- Impact of 'targeted' fluconazole prophylaxis for preterm neonates: efficacy of a highly selective approach?Journal of perinatology : official journal of the California Perinatal Association · 2012Article
- A review of Candida prophylaxis in the neonatal intensive care population.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2011Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivePrevious reports suggest a benefit of fluconazole prophylaxis in extremely low birth weight (ELBW) infants <1000 g. Our aim was to evaluate if limiting fluconazole prophylaxis to targeted highest risk infants effectively prevents invasive fungal infections, has no undesired side effects and limits unnecessary drug exposure. STUDY
designThis nonrandomized retrospective pre-post intervention study compared two groups of infants: (1) Infants <26 weeks gestation and/or <750 g birth weight, requiring central vascular access and admitted to the Monroe Carell Jr Children's Hospital at Vanderbilt neonatal intensive care unit (NICU) prior to 5 days of age, who received fluconazole prophylaxis and (2) a matched control group from the year prior to prophylaxis. This target population was selected for fluconazole prophylaxis based on prior infection control data from our institution and a number needed to treat of <15 to prevent one episode of fungemia. Following implementation and integration through the institution's computerized physician order entry (CPOE) system, provider adherence to the protocol was assessed during the prophylaxis period.
resultA total of 86 patients were included in the study, 44 in the no-prophylaxis group and 42 in the prophylaxis group. In the targeted prophylaxis group, no invasive fungal infections were observed as compared to nine infants with invasive infections in the no-prophylaxis group (P=0.004). No significant adverse effects were recorded. Targeting the highest risk infants reduced the number of infants <1000 g requiring prophylaxis from 80 to 42 (48% reduction) with no preventable infection missed. Provider compliance was 91% following implementation of this protocol through the CPOE system using a standardized order set.
conclusionTargeting the highest risk infants for fluconazole prophylaxis through CPOE can effectively prevent invasive fungal infections and limit drug exposure with no unwanted side effects.
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