Abstract
Background and aims: Fungal sepsis (FS) is an important cause of morbidity and mortality in very low birth weight(VLBW) babies. The objective of our study was to review the cases of invasive fungal infection before and after starting antifungal prophylaxis (AFP) over a 10 year period.
Methods: Retrospective review of all cases of blood culture-positive fungal sepsis before AFP (January 1999 to December 2006) and after AFP (Jan 2007 to current).
Results: There were 12 cases of blood culturepositive fungal sepsis in the 7 year period before AFP. Age at diagnosis was < 14 days in 75% of cases. Fungi isolated were Candida albicans(75%), Candida parapsilosis(17%) and Candida glabrata(8%). Major risk factors for FS were gestational age < 27 weeks, weight < 750g and preterm babies undergoing abdominal surgery for necrotising enterocolitis with the need for prolonged presence of central line.
AFP with fluconazole 3 mg/kg intravenously was commenced from Jan 2007 targeting high risk groups as above. In this period, there was expansion in cot capacity with 2614 admissions to our unit, of which 183 babies were either < 27 weeks or < 750g. Until now there have been no cases of FS in babies with strict adherence to the protocol. The only case of FS (Candida albicans) occurred on day 10 in a VLBW baby where fluconazole had not been administered as recommended.
Conclusion: AFP significantly reduces the incidence of invasive fungal infection in VLBW babies. We recommend their rational use targeting high risk babies as above.
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Shastri, A., Samarasekara, S. & Booth, D. 1395 Invasive Fungal Sepsis Before and After Institution of Antifungal Prophylaxis in a Tertiary Neonatal Unit - 10 Year Observational Study. Pediatr Res 68 (Suppl 1), 690 (2010). https://doi.org/10.1203/00006450-201011001-01395
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DOI: https://doi.org/10.1203/00006450-201011001-01395