Evaluation Of Fluconazole Regimens For Invasive Fungal Infection And Other Adverse Outcomes In Very Low Birth Weight Infants

Objective:To explore the effectiveness of fluconazole regimens in the prevention of invasive fungal infection(IFI)and other adverse outcomes in very low birth weight(VLBW)infants with more than two-week use of broad-spectrum antibiotics.Methods:A total of 373 neonates with a birth weight less than1,500g and received broad-spectrum antibiotics for more than 14 days,from January 2015 to September 2019 in the Neonatal Intensive Care Unit of Children’s Hospital of Chongqing Medical University,were retrospectively analyzed.On the basis of using fluconazole or not and the time of drug admission,73 infants were included in the universal prophylaxis group,241 were in the non-prophylaxis,59 were in the G-test[(1,3)-β-D-glucan]guidance group.Results:The overall incidence rate of IFI was 10.7%(40/373),while in the universal prophylaxis group was 2.7%(2/73),as compared with 11.6%(28/241)in the non-prophylaxis group and 16.9%(10/59)in the G-test guidance group(2.7%vs.11.6%,?~2=4.135,P=0.042;2.7%vs.16.9%,?~2=6.345,P=0.012,respectively).The mortality rates were no statistic difference in each comparative groups(6.8%vs.5.0%,?~2=0.383,P=0.746;6.8%vs.10.2%,?~2=0.471,P=0.712).The median duration of antifungal regimens showed no difference between the universal prophylaxis group and the G-test guidance group(P=0.088).No serious adverse events or fluconazole-related toxic effects were recorded.Conclusion:Preemptive fluconazole regimen guided by positive G-test for VLBW infants with more than two-week use of broad-spectrum antibiotics showed efficacy of managing adverse outcomes and minimizing drug exposure.