Efficacy of prophylactic fluconazole in reducing candidemia in high risk NICU and PICU patients

Abstract

Background: Candida infection is a common cause of morbidity and mortality in neonatal intensive care unit (NICU) and pediatric intensive care unit(PICU) patients, especially those with risk factors. Objectives: To determine the prevalence of Candida species in risky NICU and PICU patients and evaluate the efficacy of prophylactic Fluconazole in reducing Candida colonization and subsequent invasive candidemia in those patients. Design: Prospective, randomized, double blind placebo controlled clinical study. Setting: Tertiary level intensive care units at pediatric department. Subjects: 80 intensive care unit high risk group patient of neonatal and pediatric age. Intervention: children were randomly grouped during first three days to receive either Fluconazole or placebo till 28 days or less, if discharged or died earlier. Weekly surveillance cultures from oropharyngeal swabs, urine, stool and sputum (when available), samples were collected from all patients and cultured on sabaroud dextrose agar media. Blood culture on n Bact/ALERT®3D culture system for Candida detection was done when candidemia was suspected. For positive cultures, isolates were identified by API 20c biochemical identification strips. Liver enzymes were monitored. Results: Baseline risk factors for Candida infection in Fluconazole and Placebo groups were similar. Candida colonization was reported in 35 patients (87.5%) in the placebo group which was significantly higher (P =0.0001) than that detected among patients in the Fluconazole treated group [10 patients (25%)]. Fluconazole treated group showed significantly lower colonization with Candida albicans (C. albicans) and higher colonization with non Candida albicans (non-C. albicans) versus placebo group. Invasive Candida infection was significantly higher (P =0.03) among placebo group than Fluconazole treated one. Invasive non-C. albicans infection was reported in 9/13 patients [6 patients (66.6%) in Placebo group and 3 patients (33.3%) in Fluconazole treated group]. No significant hepatotoxicity was noticed during Fluconazole therapy. Conclusion: Prophylactic Fluconazole in risky neonatal and pediatric patients in ICU is effective in reducing Candida colonization especially C. albicans but not invasive candidemia.