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Routine Use of Fluconazole Prophylaxis in a Neonatal Intensive Care Unit Does Not Select Natively Fluconazole-Resistant Candida Subspecies

Manzoni, Paolo MD*; Leonessa, MariaLisa MD*; Galletto, Paolo MD*; Latino, Maria Agnese MD; Arisio, Riccardo MD; Maule, Milena MD§; Agriesti, Giovanni MD*; Gastaldo, Luca MD*; Gallo, Elena MD*; Mostert, Michael MD; Farina, Daniele MD*

The Pediatric Infectious Disease Journal: August 2008 - Volume 27 - Issue 8 - p 731-737
doi: 10.1097/INF.0b013e318170bb0c
Original Studies

Background: We have previously demonstrated efficacy against fungal colonization and infection of fluconazole prophylaxis that was routinely administered since 2001 in our ICU for preterm infants <1500 g at birth (VLBW). With prolonged use, concerns exist for the emergence of acquired fungal resistance and of Candida subspecies that are natively fluconazole-resistant (NFR), mostly Candida glabrata and Candida krusei.

Methods: We evaluated retrospectively all clinical and surveillance fungal isolates obtained from VLBW infants in our NICU during a 10-year period (1997–2006). Each fungal isolate was speciated, infants colonized or infected with NFR-Candida spp were identified and the incidence rates of colonization and infection by these fungal species were calculated. A comparison was made of the 6-year (2001–2006) prophylaxis period with the 4-year (1997–2000) preprophylaxis period.

Results: Overall, colonization by NFR-Candida spp ranged between 2.8% and 6.6% of VLBW infants yearly admitted, without any increasing trend during the study period. There were 18 of 434 (4.1%) neonates colonized by these species. Five episodes of systemic fungal infections caused by NFR-Candida spp occurred (incidence rate, 1.1%). No significant differences were detected when compared with the preprophylaxis period, when 11 of 295 infants (3.7%) were colonized by NFR-Candida spp and 4 episodes of infection occurred (1.4%) (P = 0.84 and 0.76, respectively).

Conclusions: Fluconazole prophylaxis administered to VLBW neonates in 4- to 6-week courses after birth does not lead to the emergence of natively fluconazole-resistant Candida spp.

From the *Neonatology and Hospital NICU, Departments of †Microbiology, and ‡Pathology, Azienda Ospedaliera OIRM-S. Anna, Torino; ¶Department of Pediatrics, University of Torino, and §Cancer Epidemiology Unit, CeRMS and CPO Piemonte, University of Torino, Torino, Italy.

Accepted for publication February 26, 2008.

Address for correspondence: Dr. Paolo Manzoni, MD, Neonatology and Hospital NICU, Azienda Ospedaliera Regina Margherita-S. Anna C. Spezia 60, 10136 Torino, Italy. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.