Routine use of fluconazole prophylaxis in a neonatal intensive care unit does not select natively fluconazole-resistant Candida subspecies

Pediatr Infect Dis J. 2008 Aug;27(8):731-7. doi: 10.1097/INF.0b013e318170bb0c.


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.

MeSH terms

  • Antifungal Agents / therapeutic use*
  • Candida / classification
  • Candida / drug effects*
  • Candidiasis / microbiology
  • Candidiasis / prevention & control*
  • Chemoprevention
  • Drug Resistance, Fungal*
  • Female
  • Fluconazole / therapeutic use*
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / microbiology
  • Infant, Premature, Diseases / prevention & control*
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal*
  • Male
  • Microbial Sensitivity Tests


  • Antifungal Agents
  • Fluconazole