Epidemiology and prevention of neonatal candidiasis: Fluconazole for all neonates?

Abstract

Pediatrics has led the way in infectious-disease prevention and now this can benefit one cause of nosocomial infection in preterm infants and it should be instituted in every NICU. Pediatric, infectious diseases, and neonatal organizations can help guide NICUs regarding antifungal prophylaxis, and support good epidemiologic follow-up of ICI, mortality, and fungal susceptibilities. The 2006 Report of the Committee on Infectious Diseases of the American Academy of Pediatrics (Red Book®) features a statement supporting the use of fluconazole prophylaxis in highrisk preterm infants weighing less than 1000 g (Candidiasis in Eds. Pickering et al., 2006). In striving for better outcomes for our most extremely preterm infants, from the delivery room to discharge, infection prevention is critical to decreasing many of the associated morbidities and mortality. At this time, the benefits of antifungal prophylaxis significantly outweigh any risks.With single- and multi-center randomized controlled studies and a meta-analysis demonstrating a 91% decrease of ICI in infants weighing less than 1000 g and 96% decrease in infection-related mortality, fluconazole prophylaxis should be targeted at this group of infants weighing less than 1000 g or 27 weeks or younger, due to the high mortality rate and neurodevelopmental impairment. The prevention of ICI in extremely preterm infants also eliminates Candida as a cause of mortality, as well as neurodevelopmental impairment in these vulnerable hosts. © Springer Science+Business Media, LLC 2010.